Faculty Bibliography

Assessing a patient's functional status and psychosocial conditions is accomplished more easily and with greater accuracy in the home. But how can physicians organize a database to convey information about specific clinical problems?

One of the responsibilities of the physician in overseeing home care is to periodically assess overall functional ability in the home. Specific home visits for this purpose--whether by physician aides or the physician--should incorporate a home care 'review of systems,' exploring the adequacy of the home environment, the patient's capabilities, the family's ability, and the accuracy of medication administration. Reestablishing family equilibrium following hospital discharge should begin by encouraging the hospital staff to share responsibility with the family, allowing them to 'rehearse' the roles they will play at home. The cardinal tasks for which the physician can support the family in attempting to perform are: providing emotional support for the patient, making observations, providing physical assistance, performing household chores, participating in the treatment regimen, and calling for assistance. These functions are the backbone of successful family involvement in home care, even when 'high-tech' procedures are being used. Referral to self-help groups or appropriate home health aide services is also an important role the informed physician can perform

The primary objective of this study was to test the hypothesis that inpatient care which emphasized structured, patient education, self-care and social support from a care partner (the Cooperative Care Program) is a cost-effective alternative to the more expensive staff-intensive, traditional hospital care; and that such care can be substituted without resulting in poorer outcomes with regard to subsequent health status or use of services. The effects of this program on patient and physician acceptance, patient knowledge and treatment and health status, were evaluated by means of an experimental design with comparable groups of patients assigned to experimental (cooperative care) or control (usual hospitalization) group status. Follow-up analyses of both groups of patients for a 12-month time period concluded that there were comparable and equally positive post-hospitalization experiences, with greater than 90% of both groups of patients functioning well with respect to a series of measures of functional status. There was no evidence that Cooperative Care patients were re-hospitalized more often or needed more emergency, home care or other types of services. There was, on the other hand, evidence of the positive effect on patient understanding, adherence to treatment, satisfaction, and self-management

The New York University Medical Center Cooperative Care (CC) program is a model of a delivery system of acute inpatient hospital care characterized by a live-in family member or friend acting as a 'care partner'. It has an emphasis on education in order to encourage full patient and family involvement in care during the acute hospitalization, thereby preparing both parties for management at home after discharge. The education-intensive experience of CC provides an alternative to traditional inpatient hospital care with the expected outcome of CC being to increase patient and family knowledge and satisfaction, adherence to the medical regimen, and appropriate self-management. The functioning ability of the patient-care partner team should be improved on discharge, which may result in decreased subsequent utilization of high cost healthcare resources such as rehospitalization. This paper describes the structure of the CC form of inpatient care, the types of patients appropriate for such care, and the experience of its first ten years of operation, with its implications as a replicable model for other institutions