Rj. Ackermann et Ka. Kemle, THE EFFECT OF A PHYSICIAN ASSISTANT ON THE HOSPITALIZATION OF NURSING-HOME RESIDENTS, Journal of the American Geriatrics Society, 46(5), 1998, pp. 610-614
OBJECTIVES: To describe the impact of regular visits to a nursing home
by a gerontologist physician assistant (PA) on the hospitalization an
d medical costs of patients. DESIGN: A 6-year case series (1992-1997)
incorporating events before and after introduction of a PA in May 1994
. The PA visited the nursing home 3 to 4 times per week, provided near
ly all of the acute medical care, and alternated routine visits with s
upervising physicians. SETTING: A 92-bed teaching nursing home in cent
ral Georgia. MEASUREMENTS: Demographics of the nursing home population
; hospitalizations of residents, including major diagnosis and length
of stay; number and site of all resident deaths; costs of physician an
d PA services and hospital costs. RESULTS: After the introduction of t
he physician assistant, the number of annual hospital admissions fell
by 38.0%, and the total number of hospital days per 1000 patient years
fell by 68.6% (from 4170 in 1992 to 1310 in 1997). The number of nurs
ing home visits increased by 62.1%. Annual Medicare-allowed charges fo
r MD and PA services increased by $22,304, but this was more than offs
et by a decline in hospital DRG reimbursements of $96,043. CONCLUSIONS
: The introduction of regular visits to nursing home patients by a phy
sician assistant can reduce hospitalization and medical costs of these
frail older people.