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To the Editor: The article by Dr Naylor and colleagues¹ provides valuable insight into how to reduce total cost of care while providing more home care to the elderly. Using sound principles of targeting a high-risk group, intervening with inexpensive preventive care, and setting goals that address both clinical and economic responsibility, the authors developed a system that improved care while achieving a remarkable 46% reduction in total health care cost.

The current Medicare home health care system does not come close to achieving these outcomes. The analysis by Welch et al² of 3 million Medicare home health care patients did not demonstrate success in reducing hospital bed days of care (BDOCs). In contrast, the home health care system established by the Department of Veterans Affairs, Home-Based Primary Care (VA HBPC), has demonstrated an outcome uncannily similar to the Naylor model. In the study by Naylor et al, the intervention . . . [Full Text of this Article]

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RELATED ARTICLE

Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders: A Randomized Clinical Trial
Mary D. Naylor, Dorothy Brooten, Roberta Campbell, Barbara S. Jacobsen, Mathy D. Mezey, Mark V. Pauly, and J. Sanford Schwartz
JAMA. 1999;281(7):613-620.
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