Burton J R
Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Geriatr Soc. 1994 Jul;42(7):794-6. doi: 10.1111/j.1532-5415.1994.tb06544.x.
Nursing homes typically have been a relatively isolated component of health care in the United States. Now, however, nursing homes are experiencing a change in the patients they serve. In recent years, nursing home patients have been admitted sicker and after a shorter hospital stay than in the past. Such changes are likely to continue to occur as the size of the population of frail elderly continues to increase and as insurers look for alternatives to high cost hospital care. An additional stimulus to change is that the public is asking for innovation in noninstitutionalized long-term care. This essay advocates that nursing homes are the ideal component of the health care system to lead innovative program development focused on the creation of a highly organized continuum of care for the frail elderly. Physicians must be a fundamental part of this process, providing the guidance and leadership necessary for nursing homes to evolve into comprehensive geriatrics centers. Strategies are provided for developing physician office practices in nursing homes, a fundamental first step in the process of change. Additionally, ideas are provided for developing day care centers and physician house call programs based in nursing homes. Also, tight and highly functional relationships among nursing homes and acute hospitals must be developed. The example of the Johns Hopkins Geriatrics Center is described briefly as one such program now in place.(ABSTRACT TRUNCATED AT 250 WORDS)
在美国，疗养院通常一直是医疗保健体系中相对孤立的一部分。然而现在，疗养院正经历着其所服务患者群体的变化。近年来，与过去相比，入住疗养院的患者病情更重，且住院时间更短。随着体弱老年人数量持续增加，以及保险公司寻求高成本医院护理的替代方案，此类变化可能会继续发生。促使变革的另一个因素是，公众要求在非机构化长期护理方面进行创新。本文主张，疗养院是医疗保健系统中理想的组成部分，能够引领创新项目的开发，专注于为体弱老年人创建高度有序的连续护理体系。医生必须是这一过程的基本组成部分，为疗养院发展成为综合性老年医学中心提供必要的指导和领导。文中提供了在疗养院发展医生门诊业务的策略，这是变革过程中至关重要的第一步。此外，还提供了在疗养院设立日间护理中心和医生上门服务项目的思路。同时，疗养院与急症医院之间必须建立紧密且高效的关系。文中简要介绍了约翰·霍普金斯老年医学中心的例子，它就是目前已实施的此类项目之一。（摘要截选于250字）
