A Continuum of Care for the Inner City Assessment of Its Benefits for Boston's Elderly and High-Risk Populations

• Published in: The New England journal of medicine Vol. 302; no. 26; pp. 1434 - 1440
• Main Authors: Master, Robert J, Feltin, Marie, Jainchill, John, Mark, Roger, Kavesh, William N, Rabkin, Mitchell T, Turner, Barbara, Bachrach, Sarah, Lennox, Sara
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 26.06.1980
• Subjects: Age Factors; Aged; Ambulatory care; Ambulatory Care - organization & administration; Benefits; Boston; Boston, Mass; Careers; Chronic Disease; City/Cities; Collaboration; Community Health Centers; Delivery of Health Care - economics; Delivery of Health Care - organization & administration; Elder/Elders/Elderly; Fees and Charges; Female; Geriatrics; Health care; Health facilities; Health services; Health Services for the Aged - organization & administration; Home Care Services; Hospitalization; Hospitals, Teaching; Humans; Inner city; Male; Medicine; Middle Aged; Neighborhoods; Nurse practitioners; Nursing Homes; Population; Population/Populations/ Populationists; Poverty; Poverty Areas; Public health; R&D; Research & development; Risk/Risks; Boston
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198006263022602

We describe an approach to health care in the inner city: a multidisciplinar system of physicians and mid-level practitioners that provides individualized care to chronically ill, elderly, homebound, and nursing-home residents of urban Boston who would otherwise be forced into an inappropriate reliance on teaching hospitals. Linked to four neighborhood health centers, three home-care programs, and a teaching hospital, and financially self-supporting except for the home-care component, the system cared for 3000 ambulatory, 280 homebound, and 358 nursing-home patients in the representative year described. In-hospital use, particularly hospital days, was reduced when judged by existing data for comparable (though not identical) populations. Based on stable physician practices, the system offers a workable approach to the related problems of care, manpower, and cost In the urban core. (N Engl J Med. 1980; 302:1434–40.) THE urban elderly, the medically indigent, the chronically ill, and those who are homebound or in nursing homes present complex medical and social problems with needs that require care in ambulatory settings, acute-care hospitals, chronic-care hospitals and nursing homes, as well as in the home. 1 2 3 4 If care to these groups is to be effective it must have the elements of personalization and continuity. These elements are rare in the inner city where, typically, much care occurs as a byproduct of training in hospitals that have been obliged to serve as the major recourse for many problems better handled elsewhere. 5 During . . .