Characteristics and acute care use patterns of patients in a senior living community medical practice.

OBJECTIVES: Primary care medical practices dedicated to the needs of older adults who dwell in independent and assisted living residences in senior living communities (SLCs) have been developed. To date, the demographic and acute medical care use patterns of patients in these practices have not been described.
DESIGN: A descriptive study using a 6-month retrospective record review of adults enrolled in a medical primary care practice that provides on-site primary medical care in SLCs.
SETTING: Greater Rochester, New York. PARTICIPANTS: Participants were 681 patients residing in 19 SLCs. MEASUREMENTS: Demographic and clinical data were collected. Use of acute medical care by patients in the SLC program, including phone consultation, provider emergent/urgent in-home visit, emergency department (ED) visit, and hospital admissions, were recorded. ED visit and hospital admissions at the 2 primary referral hospitals for the practice were reviewed for chief complaint and discharge plan.
RESULTS: A total of 635 (93%) of 681 records were available. The median age was 85 years (interquartile range [IQR] 77, 89). Patients were predominantly female (447, 70%) and white (465, 73%). Selected chronic medical diseases included dementia/cognitive impairment (367, 58%), cardiac disease (271, 43%), depression (246, 39%), diabetes (173, 27%), pulmonary disease (146, 23%), renal disease (118, 19%), cancer (115, 18%), and stroke/TIA (93,15%). The median Mini Mental State Examination score was 25 (IQR 19, 28; n = 446). Patients took a median of 10 medications (IQR 7, 12). Important medication classes included cardiovascular (512, 81%), hypoglycemics (117, 18%), benzodiazepines (71, 11%), dementia (194, 31%), and anticoagulants (51, 8%). Patients received acute care 1876 times (median frequency 3, IQR 2, 6) for 1504 unique medical issues. Falls were the most common complaint (399, 20%). Of these 1876 episodes, patients accessed acute care via telephone (1071, 57%), provider visit at the SLC (417, 22%), and ED visit (388, 21%). Of the cases conducted via telephone, 693 (67%) were resolved by phone, 253 (24%) required home visits, 15 (1%) required subspecialist follow-up, and 81 (8%) required ED evaluation. Of the cases prompting a home visit by a medical provider, 399 (96%) were resolved during the visit, 13 (3%) required subspecialist follow-up, and 4 (1%) required ED evaluation. Of the 389 cases conducted via ED visit, 164 (42%) were admitted to the hospital and 2 (0.5%) died.
CONCLUSION: SLC primary care medical practices serve a population that is older, has significant medical comorbidity, and frequently accesses acute medical care. Although many acute care issues for this population are handled via phone, home visits and/or ED use is common. Understanding the acute care health utilization patterns of SLC dwellers is critical to designing systems to optimally address the acute care needs of aging older adults. Copyright Â