Abstract: The Effect of a Physician Assistant on the Hospitalization of Nursing Home Residents

Richard J. Ackermann, MD, and Kathy A. Kemle, MS, PA-C. "The Effect of Physician Assistant on the Hospitalization of Nursing Home Residents." Journal of the American Geriatrics Society 46 (May 1998) 5: 610-14.

Objectives:
* It has been suggested that improved primary care in the nursing home might decrease the number of times residents must be hospitalized, thus reducing costs while increasing the quality of patient care. Ackermann and Kemle test this theory, describing how regular visits to a nursing home by a gerontologist physician assistant (PA) influenced the rates of hospitalization and medical costs for nursing home residents.

Methods:
* The study was conducted at a 92-bed, private nursing home in Georgia, over a period of six years (1992-97). Data concerning the hospitalizations of residents, number and site of all deaths, and costs of physician and PA services and hospital costs was collected for two periods. The first period included events before the PA began making regular visits to the nursing home in May 1994, and the second included events following the introduction of the PA. The data for these two periods was then compared to determine the effect of the PA's visits on cost and patient care.
* Beginning in May 1994, the PA visited the nursing home 3 to 4 times per week, providing nearly all the acute medical care administered to residents, and alternated routine visits with supervising physicians.

Results:
* "The number of hospital admissions/1000 patient years fell 38.0%, from 598 to 371, during the study period, while the number of hospital days/1000 patient years decreased 68.6%, from 4170 to 1310."
* Prior to the introduction of the PA, 1120 nursing home visits were typically made by health care professionals. By 1997, following the introduction of the PA, the number of professional visits increased to 1815 per year.
* Following the introduction of the PA, there was a 46.6% ($22,304) increase in professional charges (fees for the services of physicians and PAs); however, this was more than compensated for by a $96,043 decrease in hospital charges.

Conclusions:
* "Frequent visits by a qualified provider are likely the most important factor in reducing hospitalization of nursing home residents, and patients who need hospitalization often return earlier to the nursing home. . . . The availability of prompt laboratory, radiologic, and electrocardiogram services, along with the administration of parenteral medications when necessary, allows serious disease to be evaluated and treated in the facility."
* Regular visits to nursing homes by a PA result in lower net medical costs, as care is provided in a more efficient and timely manner.

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