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Review: Composition of care team critical to improved outcomes for nursing home patients


INDIANAPOLIS — An interdisciplinary team that actively involves a nursing home patient’s own physician plus a pharmacist has substantially better odds of improving the quality of nursing home care, according to a new systemic review of studies on long-term-stay patients’ care.

“CMS [Centers for Medicare & Medicaid Services] mandates an interdisciplinary approach to nursing home care, so all U.S. nursing homes have teams, but the composition and activity of these teams vary,” said Arif Nazir, M.D., Indiana University Center for Aging Research center scientist and assistant professor of clinical medicine at the IU School of Medicine. Dr. Nazir is the first author of the review, which looked at studies conducted over two decades on four continents.

“We found that having the doctor who actually cares for the nursing home patient involved on the care team has a positive impact on patient outcome, as did including a pharmacist on the team,” he said. “Interdisciplinary teams that took this approach had a higher success rates in decreasing falls, improving behavioral issues and prescribing less antipsychotic medications.”

Dr. Nazir is past president of the Indiana Medical Directors Association and currently serves on the board of directors of the American Medical Directors Association. Medical directors are physicians dedicated to long-term care medicine.

The review appears online in advance of publication in the July issue of the Journal of the American Medical Directors Association.

When considering a nursing home placement for a loved one, Dr. Nazir suggests family members ask facilities specifics about the care team. How regularly is a resident’s own physician involved? Does a pharmacist routinely attend care planning meetings?

“Recent efforts to transform our health care system focus on team-based care delivery,” said Regenstrief Institute investigator Malaz Boustani, M.D., MPH, IU Center for Aging Research associate director and associate professor of medicine at the IU School of Medicine. “This comprehensive study provides specific information to develop an effective health care delivery team.”

Dr. Boustani is senior author of the review paper. He sees patients at Wishard-Eskenazi Health and at IU Health, and he is the research director of Indianapolis Discovery Network for Dementia.

In addition to Drs. Nazir and Boustani, co-authors of “Systematic Review of Interdisciplinary Interventions in Nursing Homes” are Kathleen Unroe, M.D., and Babar Khan, M.D., of the Regenstrief Institute, IU Center for Aging Research and the IU School of Medicine; and Monica Tegeler, M.D., and Jose Azar, M.D., of the IU School of Medicine. Dr. Tegeler is president of the Indiana Medical Directors Association.

The study was funded by the U.S. Department of Health and Human Services’ Health Resources and Services Administration, grant K01HP20517.