OBJECTIVE: To evaluate the effectiveness of a primary care case management model for Medicare beneficiaries that includes team care; provider education; disease & pre/post hospital management; and, an integrated reporting & feedback system. The study is comparing the effectiveness of the model in an “at-risk” sample of Medicare beneficiaries.
DESIGN: A 36 month, longitudinal treatment control group design.
STUDY SAMPLE: The study sample consists of 677 Medicare beneficiaries (treatment group = 400, control group = 277) and were determined to be at increased risk for health and functional decline and/or increased health service use by a pre-defined scoring algorithm.
INTERVENTION: The intervention consists of collaborative care teams that combine primary care physicians, nurses, patients and health/community services and includes patient targeting and screening, clinical assessment, monitoring, care planning, arrangement and coordination of needed services, ongoing follow-up, patient education and information reporting to the geriatric primary care teams.
METHODS: Anderson’s Behavioral Model for Vulnerable Populations was used as the framework for evaluating patient specific outcomes, including mortality, health and functional status, preventive health behaviors, health service use and satisfaction with care.
CONCLUSIONS: After adjusting for baseline differences, the treatment group members were: 34% less likely to be hospitalized two or more times; were hospitalized fewer times (P=.01); had an adjusted mean bed days that were 3.5 days less (P=.03) than that of the control group; their length of stay was almost one day less per stay (P=.04); and, had an adjusted mean difference of $173 per member per month (PMPM) (P=.02).
IMPLICATIONS: Results indicate that a primary care case management model, which emphasizes disease and health management components, may be more effective than traditional utilization management approaches employed by HMOs and has the potential to positively impact service use and cost of care for selected elderly patients in Medicare risk plans.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003