Paper
Wednesday, July 11, 2007
Longitudinal Evaluation of Care Management for Elderly Patients with Comorbidities
Cheryl Schraeder, RN, PhD, FAAN, Health Systems Research Center, Carle Foundation Hospital, Mahomet, IL, USA
| Learning Objective #1: 1. Summarize and identify the core components of the Care Management Model. |
| Learning Objective #2: 2. Define and evaluate 36 and 48 month major study findings and their implications for the nursing profession. |
This study is a prospective, randomized clinical trial testing a coordinated care model on its ability to improve clinical care and use of Medicare covered health services. The intervention provides care and disease management services to elderly patients from primary care teams (primary care physician, nurses and patients). The intervention is based on the core components of the Chronic Care Model. The study sample consists of 2,301 individuals who enrolled between April 2002 and April 2003 (control group = 1,140; intervention group = 1,161). This report describes outcomes at 36 and 48 months post enrollment using intent-to-treat methodology. Outcome data are collected from several sources: patient self-report, electronic laboratory results, medical record review and Medicare claims files. Multivariate regression models were used to estimate adjusted outcomes. At the end of 36 months there were significant outcome differences between the intervention and control groups. Intervention patients had higher satisfaction scores, patients with diabetes reported higher rates of annual foot exams and patients with CHF reported higher rates of daily weighing. Intervention patients reported higher rates of lipids testing and patients with diabetes had higher rates of albuminuria testing. Intervention patients had higher rates of blood pressure control. These results are similar at 48 months with 62% of the study population reporting outcomes. Results will also be presented on health service encounters and Medicare costs for the first 33 months of program operation. In addition, nursing time and related activities will be discussed for the intervention group. These findings indicate promising results can be achieved when nurses work in partnership with primary care physicians utilizing care/disease management interventions to manage elders with comorbidities. They also underscore the unique challenges effective interventions face with this patient population.