ADVANCING GERIATRIC NURSING PRACTICE: Geriatric Nurse Practitioners in Long‐Term Care: Demonstration of Effectiveness in Managed Care

Abstract

The use of GNPs in collaboration with physicians reduced ED and acute care utilization costs as well as overall costs for a cohort of HMO enrollees in long-term care. This encouraged the HMO to support the concept that all long-term care HMO residents should be covered by GNP/MD teams.

RETRACTED: Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care

“…49,50 With the institution of diagnosis-related group payment systems in acute care hospitals, there was substantial motivation to reduce hospital bed days. Since then, hospitals have discharged patients "quicker and sicker" into nursing homes.…”

Expanding the Knowledge Base of Resident and Facility Outcomes of Care Delivered by Advanced Practice Nurses in Long-Term Care

“…Much of the empiric evidence regarding the link between APN nursing home practice and positive resident outcomes relies on multiple reports of a single study of the EverCare demonstration project in five geographic locations, using administrative data in large part (Kane et al, 2001;Kane et al, 2002;Kane et al, 2004). Some studies were limited by the use of retrospective chart review (Burl, Bonner, Rao, & Khan, 1998) or by a survey that failed to report reliability or validity of the survey instrument (Abdallah, 2005). As well, the literature includes description of practice models implemented by APNs in one longterm care setting (Kennedy et al, 2000;Smith et al, 1995) or used relatively small sample sizes in a few facilities (Evans et al, 1997;Ryden et al, 2000).…”

“…Only a few studies were identified that specifically linked the outcomes of APN practice with nursing home residents on the costs of that care. For example, a cost-effectiveness analysis of a geriatric nurse practitioner (gNP) and physician (MD) collaboration versus an MD-alone practice included transfer to emergency departments and acute and subacute care days as outcome variables (Burl et al, 1998). APN and physician teams providing care to HMO enrollees in 45 long-term care facilities were associated with lowering the cost of care as compared with physician care alone.…”

Skilled Nursing Facilities and Post Acute Care

“…Studies also demonstrated that collaboration with midlevel practitioners including nurse practitioners (NPs) and physician assistants (PAs) in the post acute care period enhanced overall patients care, reduced emergency department use and hospitalization [49][50][51].…”

“…Increased patient-physician communication is associated with improved outcomes [47]. Medico-legal case reports have associated poor interphysician communication with serious adverse outcomes [48].Studies also demonstrated that collaboration with midlevel practitioners including nurse practitioners (NPs) and physician assistants (PAs) in the post acute care period enhanced overall patients care, reduced emergency department use and hospitalization [49][50][51].Utilization of pharmacy consultants, monitoring for drug interactions, pharmacotherapy optimization and medication reconciliation during the various transfer process of the residents may also result in improvement in health care outcomes. Discussion and review of treatment goals and post discharge plan between the patient and family using an interdisciplinary team approach is crucial for success.…”