Assuntos
Diretivas Antecipadas , Documentação/normas , Registros Eletrônicos de Saúde , Idoso , Tomada de Decisões , Feminino , Humanos , Masculino , Competência Mental , Preferência do Paciente , Procurador , Estados Unidos , United States Department of Veterans Affairs , Interface Usuário-Computador , VeteranosRESUMO
OBJECTIVES: Describe how an interdisciplinary home-based primary care program (HBPC) affected hospital and emergency department (ED) use in an urban Veterans Affairs medical center. DESIGN: A retrospective review. SETTING: HBPC of the Washington, DC, Veterans Affairs Medical Center (VAMC-DC). PARTICIPANTS: All HBPC patients enrolled for at least 6 months during the period of January 1, 2001 through December 31, 2002. MEASUREMENTS: Baseline demographic variables (such as age, gender, race, living arrangement, community services used), major medical diagnoses, functional measures (MMSE, ADL, IADL, Braden), advance directives, episodes of ED, and hospital use for the 6-month period before and after HBPC enrollment from the VAMC-DC and discharge status (obtained from electronic medical records). RESULTS: A total of 183 patients were enrolled in HBPC for at least 6 months during the 24-month study period. Ninety-five percent were male with a mean age of 73.6 years (range 36 to 95). Most were African American (71%) and lived with a caregiver (65%). The average number of comorbidities was 6 per patient. At the end of the 2-year study period, 45% remained active in HBPC and 17% had died. Using paired score analysis t tests, patients enrolled in HBPC for 6 months had 43.7% fewer hospital admissions (P = .001) and spent 49.9% fewer days in the hospital (P = .001). The 18.5% reduction in ED visits was not statistically significant (P = .2632). CONCLUSIONS: Use of HBPC for 6 months for frail chronically ill patients in an urban VAMC may be associated with fewer hospital admissions resulting in reduced total hospital days, but no significant change in ED use.
