Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people

Abstract

Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people Aim. The purpose of this study was to test the effectiveness of a collaborative primary care nurse case management intervention emphasising collaboration between physicians, nurses and patients, risk identification, comprehensive assessment, collaborative planning, health monitoring, patient education and transitional care on healthcare utilisation and cost for community dwelling chronically ill older persons. Background. Primary care teams comprised of nurses and primary care physicians have been suggested as a model for providing quality care to the chronically ill, but this type of intervention has not been systematically evaluated. Design. A non-randomised, 36 month comparison of two geographically distinct primary care populations was conducted. Methods. Six hundred and seventy-seven persons aged 65 and older were determined to be at high-risk for mortality, functional decline, or increased health service use. The treatment group (n = 400) received the intervention and the comparison group (n = 277) received usual care. Health plan claims files provided data on number of hospitalisations and bed days, emergency department (ED) visits, physician visits and total cost of care.Results. After adjustment for baseline variables, there were no significant differences between the treatment and comparison group in the percentage of patients hospitalised or ED visits. However, among those hospitalised in the treatment group, the likelihood of being re-hospitalised was significantly reduced by 34% (p = 0AE032). After adjusting for the cost of the intervention, although not statistically significant, the reduced hospital use resulted in cost savings of $106 per patient per month in the treatment group.Conclusions. The results indicate that a collaborative primary care nurse case management intervention has the potential to be an effective alternative to current primary care delivery system practice.Relevance to clinical practice. The study suggests that a chronic care intervention emphasising collaboration between physicians, nurses and patients, may be more effective when implemented in integrated provider networks.

Nurse-led case management for community dwelling older people: an explorative study of models and costs

“…1999, Montgomery & Fallis 2003, Gravelle et al. 2007, Schraeder et al. 2008), and some commentators (Hutt et al.…”

“…It is gener-ally associated with high patient satisfaction (National Primary Care Research and Development Centre 2006), and improved quality of life, functioning (Stolee et al 2003, Black 2007, Sutherland & Hayter 2009) and continuity of care (Van Acterberg et al 1996, Singh 2005. Some studies suggest that case management successfully reduces emergency hospital admissions and associated costs (Bernabei et al 1998, Kane et al 2003, Leung et al 2004, Duke 2005, but other evidence (Gagnon et al 1999, Montgomery & Fallis 2003, Gravelle et al 2007, Schraeder et al 2008, and some commentators (Hutt et al 2004, Black 2007, suggest that it has no impact on such outcomes, or that the evidence is inconsistent (Congressional Budget Office 2004, Singh 2005, University of Birmingham 2006.…”

Identifying nurse practitioners' required case management competencies in health promotion practice in municipal public primary health care. A two‐stage modified Delphi study

“…For example, nurse case management has been found to significantly reduce re-hospitalisation related to cardiovascular symptoms and morbidity (Berra 2011). However, nurse case management, including monitoring, has been found to improve self-care, disease and medication education, as has counselling in chronically ill older adults, leading to fewer admissions (Schraeder et al 2008). In addition, in single studies, such as those concerned with women who suffer from depression, nurse case management has been found to improve the patients' knowledge of medication and mental status (Kneipp et al 2011).…”

Case management and self-management support for frequent users with chronic disease in primary care: a pragmatic randomized controlled trial

“…The expansion of case management within FMG will allow, together with the case management services already offered by the CSSS, a better response to the complex needs of vulnerable patients, as well as improved services integration. Case management will be performed in the primary care setting, the FMG, ensuring a better collaboration between case management nurse and family doctor [25]. The presence of a primary contact (FMG nurse), who is a generalist and accessible, will promote the coordination of patient care.…”

“…First, case management by primary care nurses has proven to be effective for various CD [25-27]. In fact, a key element of the effectiveness of an interdisciplinary approach to CD for vulnerable primary care patients is the use of a single caregiver (usually a nurse) to serve as the main contact and to coordinate interventions between health care professionals and the services provided [28].…”