The ironic business case for chronic care in the acute care setting.

The U.S. health care system provides acute care tools to deal with the problems of chronic disease, and strategies are needed to engage hospitals in chronic care innovations. Acute care-based models that improve chronic care have been developed, but their diffusion is limited by the absence of a business case for adoption. Yet a financial case for improving chronic care is possible by aggregating previously tested models into a service line that can be customized to local circumstances. Beyond benefits to hospitals, patients and payers could benefit from improved patient outcomes and costs; society could benefit from more appropriate deployment of resources.

[1]  C. O. Kennedy A controlled trial , 1971, British Homeopathic Journal.

[2]  R. Fortinsky,et al.  A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. , 1995, The New England journal of medicine.

[3]  R. Fortinsky,et al.  Do Acute Care for Elders Units Increase Hospital Costs? A Cost Analysis Using the Hospital Perspective , 1997, Journal of the American Geriatrics Society.

[4]  B. Jonathan Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial , 1999 .

[5]  P. Sandercock,et al.  Framework for design and evaluation of complex interventions to improve health , 2000, BMJ : British Medical Journal.

[6]  R. Fortinsky,et al.  Effects of a Multicomponent Intervention on Functional Outcomes and Process of Care in Hospitalized Older Patients: A Randomized Controlled Trial of Acute Care for Elders (ACE) in a Community Hospital , 2000, Journal of the American Geriatrics Society.

[7]  Inda,et al.  A multicomponent intervention to prevent delirium in hospitalized older patients. , 1999, The New England journal of medicine.

[8]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[9]  Christianna S. Williams,et al.  Multicomponent Targeted Intervention to Prevent Delirium in Hospitalized Older Patients: What is the Economic Value? , 2001, Medical care.

[10]  S Shepperd,et al.  Hospital at home versus in-patient hospital care. , 2005, The Cochrane database of systematic reviews.

[11]  B. Starfield,et al.  Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. , 2002, Archives of internal medicine.

[12]  P. Lavori,et al.  A controlled trial of inpatient and outpatient geriatric evaluation and management. , 2002, The New England journal of medicine.

[13]  Thomas J. Smith,et al.  A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. , 2003, Journal of palliative medicine.

[14]  S. Inouye,et al.  Translating Research into Clinical Practice: Making Change Happen , 2004, Journal of the American Geriatrics Society.

[15]  T. Fulmer,et al.  Nurses Improving Care to Health System Elders (NICHE): Implementation of Best Practice Models , 2004, The Journal of nursing administration.

[16]  D. Meier,et al.  Clinical practice. Palliative care. , 2004, The New England journal of medicine.

[17]  A. Kramer,et al.  Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention , 2004, Journal of the American Geriatrics Society.

[18]  Donald Steinwachs,et al.  Hospital at Home: Feasibility and Outcomes of a Program To Provide Hospital-Level Care at Home for Acutely Ill Older Patients , 2005, Annals of Internal Medicine.

[19]  S Shepperd,et al.  Hospital at home versus in-patient hospital care. , 2005, The Cochrane database of systematic reviews.

[20]  T. Holford,et al.  Consequences of Preventing Delirium in Hospitalized Older Adults on Nursing Home Costs , 2005, Journal of the American Geriatrics Society.

[21]  C. Boult,et al.  Moving beyond Round Pegs and Square Holes: Restructuring Medicare To Improve Chronic Care , 2005, Annals of Internal Medicine.

[22]  S. Inouye,et al.  Replicating the Hospital Elder Life Program in a Community Hospital and Demonstrating Effectiveness Using Quality Improvement Methodology , 2006, Journal of the American Geriatrics Society.

[23]  Catherine Eng,et al.  Rates of Acute Care Admissions for Frail Older People Living with Met Versus Unmet Activity of Daily Living Needs , 2006, Journal of the American Geriatrics Society.

[24]  Chad Boult,et al.  Guided care for multimorbid older adults. , 2007, The Gerontologist.

[25]  J. Arvantes MEDICAL HOME GAINS PROMINENCE WITH AAFP OVERSIGHT , 2008, The Annals of Family Medicine.

[26]  D. Meier,et al.  Cost savings associated with US hospital palliative care consultation programs. , 2008, Archives of internal medicine.

[27]  Stephen M Shortell,et al.  Measuring the medical home infrastructure in large medical groups. , 2008, Health affairs.