Doyle A, Masland J
East Boston Neighborhood Health Center, MA 02128, USA.
Health Policy. 1997 Sep;41 Suppl:S145-62. doi: 10.1016/s0168-8510(97)00044-4.
With the growth in frail elderly populations, health providers and policymakers are exploring new models of caring for and financing the care of disabled elders. This paper reviews innovative care programs directed toward maintaining elders with dependency-producing physical and mental disabilities in home and community-based programs, and toward minimizing the use of acute and long-term institutional care. These programs represent improvements over the traditional fragmented care and financing mechanisms by integrating patient management responsibilities into one provider organization. Some programs integrate only primary and acute care, while others integrate only the continuum of long-term care services. A third set of programs, the key focus of this paper, integrate the full continuum of care from primary through acute and long-term care services. Coupled with service integration is financial consolidation, with control over all sources of funds transferred to the managing provider along with some level of financial risk. Outcomes in terms of lowered acute care utilization and successful site duplication are described, and future prospects for program adoption on a national scale are addressed.
随着体弱老年人口的增加，医疗服务提供者和政策制定者正在探索照顾残疾老年人以及为其护理提供资金的新模式。本文回顾了创新护理项目，这些项目旨在让患有导致生活不能自理的身心残疾的老年人维持家庭和社区护理项目，并尽量减少急性和长期机构护理的使用。这些项目通过将患者管理责任整合到一个服务提供机构，改进了传统的分散式护理和融资机制。一些项目仅整合了初级和急性护理，而其他项目仅整合了长期护理服务的连续过程。本文重点关注的第三类项目整合了从初级到急性和长期护理服务的完整护理连续过程。与服务整合相伴的是财务合并，即对所有资金来源的控制权与一定程度的财务风险一同转移给管理服务提供者。文中描述了降低急性护理利用率和成功复制试点项目的成果，并探讨了在全国范围内采用这些项目的未来前景。
