Golden Adam G, Martin Shanique, da Silva Melanie, Roos Bernard A
Miami VAMC GRECC (11GRC), FL 33125, USA.
Care Manag J. 2011;12(2):54-9. doi: 10.1891/1521-0987.12.2.54.
After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical social and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.
住院后，许多老年人需要专业护理。尽管一些患者在家中接受服务，但其他患者则被收治到专业护理机构。在当前分散的医疗保健系统中，医院在经济上受到激励，要尽快将体弱的老年人转至机构接受急性后期护理。同样，许多专业护理机构也受到激励，要延长住院后的护理期，并将患者转至监护型养老院护理。由此导致的机构式专业护理的过度使用，可能会带来各种不良的医疗、社会和经济后果。为更高效有效地使用专业护理机构而进行的护理管理干预措施，必须考虑到决定将患者收治并留在专业护理机构中的各种因素。在我们等待解决这些障碍的医疗保健改革努力之际，护理管理人员已经有机会改善当前的急性后期过渡流程。
