Paul Shelton

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.

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

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

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.

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

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.

Carle's Diabetes Management Program

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 Effects of a Collaborative Model of Primary Care on the Mortality and Hospital Use of Community-Dwelling Older Adults

Diabetes mellitus (DM) is a chronic disease increasing in epidemic proportions. It is estimated that approximately 16 million Americans have DM and 200,000 each year die from its complications (Boyle et al., 2001). Diagnosed cases of DM are expected to increase dramatically in coming years, primarily related to our eating behavior (obesity) and sedentary lifestyle (lack of physical activity; Flegal et al., 2002). Diabetes mellitus has its greatest effects on the elderly; one in five adults, 65 and older, has diabetes (Modkad et al., 2001) and approximately 66% of diabetes-related expenditures are for the care of the elderly (Basile, 2000). Over the past 30 years, DM care has been at the forefront of the changes in disease management (Griffin, 2001). The majority of patients with DM are inadequately treated despite the proliferation of medical guidelines specifying optimal management of the disease and there are wide variations in care (Saaddine et al., 2002). The most pressing problem in DM care is the poor translation of this accumulated knowledge into routine clinical practice (Berger and Muhlhauser, 1999). These pressing reasons provided strong motivation and incentive for the Carle health care system to make patients with DM a priority focus for the organization. The purpose of this chapter is to present an overview of the Carle diabetes management program and our achievements to date.