Nursing Home Innovation in the Public Arena

Nursing homes in urban Boston during the early 1970s were dependent on emergency wards and outpatient departments for primary medical care of their residents. The Boston City Hospital Telemedicine program, later to become part of the Urban Medical Group, was an innovative approach to dealing with this problem through the use of teams consisting of nurse practitioners, physician assistants, and physicians. This approach, which emphasized the delivery of primary medical care at the nursing home, reduced the use of hospital-based services and improved continuity of care. This article describes the development of the concept and the challenges encountered at the state and federal levels in expanding the program.