(provided by the investigator): Faced with Medicare payment cuts, unfavorable Medicare reimbursement to support geriatric team care, a shrinking supply of geriatricians, a growing aging population, and a fragmented health care delivery system, health care organizations have to find creative ways to achieve optimal integrated quality primary care for their elderly patients. This dissertation research is a case study of the Elliot Physician Network (EPN), which is the primary care entity of the Elliot Health System (EHS), based in New Hampshire. The EHS is an organized delivery system that is currently undergoing a culture change. It is transitioning its core business to primary care instead of inpatient hospital acute care and integrating its clinical care services across the different EHS entities. To support the culture change and to reshape its primary care network to best serve its growing aging population, the EHS has implemented an EpicCare electronic medical record and has invested in a 20,000 square foot, one-stop, multi-services Senior Health Center (SHC) in the city of Manchester that is based on an interdisciplinary geriatrics team care model. The Manchester-SHC of the EHS serves as an excellent site to study coordination of elderly primary care and clinical integration because it is one of a few sites in the US offering a wide range of services catered to elders in one stop. In particular, this dissertation research has four aims. To: 1) Measure the relationship between receipt of an annual physical exam visit and physician recommendation of evidence-based preventive services;2) Evaluate whether there is a significant difference between the interdisciplinary geriatrics Manchester Senior Health Center care model and the traditional primary care model in the receipt of referrals for: A) physical therapy for patients diagnosed with degenerative joint disease (osteoarthritis) or cerebrovascular disease (stroke) and B) geropsychiatric care for patients diagnosed with memory loss, dementia, or depression;3) Identify when providers and patients discuss preventive services in the two models of care, how they assess risks for an elderly patient, develop a treatment plan, and monitor patients'progress, and how they coordinate care for patients needing multiple services across care settings;and 4) Measure the impact of the team care model on patients'use of outpatient services and inpatient services offered at the EHS. Data will be drawn from EPN 2001-06 panel administrative data, Elliot Hospital data, and face-to-face interviews with selected PC providers and their support staff members. Quantitative data analyses will be conducted using fixed-effect and difference-in-difference models. Qualitative data will be used to inform interpretation of quantitative analyses. Results of this study will help to develop strategies for delivering continuous, effective, evidence-based preventive services to elders.
Faced with Medicare payment cuts, unfavorable Medicare reimbursement to support geriatric team care, a shrinking supply of geriatricians, a growing aging population, and a fragmented health care delivery system, health care organizations have to find creative ways to achieve optimal integrated quality primary care for their elderly patients. This dissertation research is a case study of a health system that is currently undergoing a culture change by 1) transitioning its core business to primary care instead of inpatient acute care and 2) investing in a unique, one-stop, multi-services Senior Health Center to better serve its elderly patients. Results of this study will help to develop strategies for delivering continuous, effective, evidence-based preventive services to elders.
