Cheryl Schraeder

Caregivers' utilization of health services: Results from the Medicare Alzheimer's Disease Demonstration, Illinois site

OBJECTIVES: The purpose of this study is to examine the effect of the Medicare Alzheimers Disease Demonstration and Evaluation (MADDE) conducted in Illinois on the use of health services and Medicare expenditures by caregivers of persons with dementia.

Managing elders with comorbidities

Carles Medicare Coordinated Care Demonstration care/disease management interventional components, based on the chronic care model, are described for elderly patients in 13 counties in Illinois. Patients enrolled in the program are diagnosed with chronic obstructive pulmonary disease, coronary artery disease, diabetes, atrial fibrillation, or congestive heart failure. Primary care teams are made up of a primary care physician, an advanced practice nurse, a nurse case manager, and a case assistant. The patient/family is the cornerstone of the intervention, which is evaluated using a prospective, longitudinal randomized treatment-control design.

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 = 0·032). After adjusting for the cost of the intervention, although not statistically significant, the reduced hospital use resulted in cost savings of

The effect of primary care management on lipids testing and LDL-C control of elderly patients with comorbidities.

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.

The Carle Clinic.

Purpose This article presents results of a randomized clinical trial evaluating the effectiveness of the Medicare Coordinated Care Demonstration, Illinois site, on selected clinical outcomes over 36 months. Primary Practice Settings Interdisciplinary teams, located at primary care practices, provided case and disease management services to 999 patients. Results Intervention group patients had higher lipids-testing rates during the first 2 years than control group patients. Once tested, more than 80% of patients in both groups were retested in subsequent years. There were no differences in the percentage of intervention group patients who were in low-density lipoprotein cholesterol (LDL-C) control at program entry and at the end of 36 months as compared with control group patients (maintained control). However, a higher percentage of intervention group patients who were not in the LDL-C control at baseline were in control after 36 months as compared with control group patients (achieved control). Implications for Case Management Practice This study suggests that physician—nurse case management team care has the potential to augment the effectiveness of primary care by increasing adherence to testing protocols among elderly patients with multiple chronic illnesses, but this effect diminishes over time as guidelines are adopted into general practice. It suggests that LDL-C therapeutic control can be improved through increased lipids testing and the use of lipid-lowering medications. The results also indicate that care management strategies targeting more intensive patients versus less intensive patients are cost-effective strategies that can be expanded beyond lipids testing and control to other clinical health status measures.

Population-based research data as a means to address health outcomes.

Confronting the challenge of effective, efficient health care for the elderly has led to many variations in service delivery modalities. The approach employed by the Community Nursing Organization (CNO) is based on nurse coordinated care. Nurses are integrally involved in the authorization, coordination, evaluation and payment of services. The nursing role encompasses case management, including coordination of non-CNO covered services as well as those provided through the capitated payment schedule. Thus, in addition to authorizing CNO services, the nurse also may coordinate services such as physician visits, home repair, transportation, respite services and home-delivered meals, even though they are not covered financially under the auspices of the CNO. Preliminary findings indicate that this model may be successful clinically and financially by determining and utilizing an appropriate mix, intensity and duration of services.

Case Management Issues in Rural Long-Term Care Models

Health care restructuring efforts have been influenced by changes in pubic policy, payment mechanisms, and societal values. In todays environment, leading issues focus on quality and cost-effective care. Health care systems are moving from a concentration on structures and processes of care to an expanded view that encompasses the exploration, documentation, and improvement of patient outcomes. This article presents an overview of the domains of health outcomes, widely used surveys in the measurement of outcomes, methodological issues related to interpreting outcome measures, and trends for clinical practice and future research.

Integrated risk assessment and feedback reporting for clinical decision making in a Medicare risk plan

This article reviews research on some of the more visible long-term care case-management systems. In particular, the two generations of the Social Health

Clinical and health service research needs in the group practice organization.

The challenge of tapping into the rich resource of population-based, aggregated data to inform and guide clinical processes remains one of the largely unrealized potentials of managed care. This article describes a multifaceted approach of using health-related data to support providers in clinical decision making as an adjunct to case management and primary care delivery. The goal is to provide data that can be used for clinical decision making that is population based, yet individualized for specific patient care situations. Information reporting holds great potential in the clinical care of patients because it can be used to identify persons who could benefit from early detection, intervention, or treatment. It has been suggested that one of the keys to success in managed Medicare is the timely use of information that is detailed, comprehensive, and real-time describing key parameters of clinical encounters.

The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit.

Clinical and health services research will play a more Important role in group practice organizations because it provides a vehicle to identify and answer critical questions. Study initiatives can identify, describe, quantify, and help predict trends in clinical practice. Systematic investigation is a means to link structure and processes of care to clinical parameters, patient outcomes, and cost variables. Findings can be used to support sound clinical, quality of care, and educational decision making. The ultimate goal of research is to promote the appropriate access and delivery of quality care In a cost-effective manner.