The importance of physician presence in nursing homes for residents with dementia and pneumonia.

OBJECTIVE To study whether physician presence in the nursing home is related to clinical decision making, certainty, and honoring care preferences for patients with dementia and pneumonia. DESIGN Cross-sectional survey of physicians. SETTING Nursing homes in the United States and the Netherlands. PARTICIPANTS Twenty-four US and 38 Dutch physicians who provide care for nursing home patients. MEASUREMENTS Physicians reported their presence in the nursing home, diagnostic and treatment decisions for patients with dementia who had pneumonia, certainty about the diagnosis and patient and family preferences, and the extent to which they honored these preferences. These variables were examined in reference to physician presence in the nursing home. RESULTS Physicians with higher nursing home presence were less likely to order a chest x-ray and to hospitalize patients with dementia and pneumonia, although this difference was not significant when adjusted for country. They also were more likely to be certain of family preferences, a difference that held even when adjusted for the strong confounder of country. CONCLUSION Physician presence in the nursing home relates to some treatment decisions for patients with dementia and pneumonia. Policies that affect physician presence may change health care practices and related costs. Future studies should more closely examine how physicians use their time so as to better understand the importance of presence and what the US health care system might learn from the Dutch system.