Care Management Outcomes

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Care Management Outcomes

• Michal Boyd, RN, NP, ND
• Auckland University of Technology
• Waitemata DHB

2
Care Management Research

• Extremely variable outcomes due to
• Extremely variable definitions of Care
  Coordination/Care Management
• Extremely variable intervention
• Extremely variable research methods
• Quasi experimental Pre-Post designs
• RCT design

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COPD Care Management
4
Comprehensive Geriatric AssessmentFollow Up
Essential

• Stuck et al.
• A trial of annual in-home comprehensive geriatric
  assessments for elderly people living in the
  community
• 1995, NEJM
• Combined home visits with Comprehensive Geriatric
  Assessments
• 85 fewer Nursing Home days/100 persons/year
• More of the intervention group was likely to use
  services that promoted socialization

• Nikolaus et al.
• A randomized trial of comprehensive geriatric
  assessment and home intervention in the care of
  hospitalized patients, Age and Ageing, 1999
• Life satisfaction, and self-perceived health
  score significantly greater in trial group
• Hospital and long term care length of stay
  significantly reduced

5
Naylor and Brooten 2002Advanced Practice Nurses
in Transitional Care (Journal of Nursing
Scholarship 34 (4), 369)

• Dose Effect adding home visits reduced
  rehospitalisations
• Comprehensive Discharge planning was helpful, but
  most patients needed didnt retain teaching
  information when they went home
• The success of the model depends on
• Provision of coordinated care across settings
• Specialist APN knowledge and skills
• Ability to negotiate and collaboroate with
  families, physicians, and other providers
• Coordinate complex therapeutic regimes
• Strong teaching and counseling skills
• Strong patient advocacy skills

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Unique Care UKPrimary Care Care Management
7
Care Management Outcomes (Boyd, et al. 1996)

• Decreased Hospitalisations
• Decreased Emergency Department Visits
• Decreased Physician Visits by Approximately 1/3
• Decreased Hospital Costs when compared to the
  control group approx. 100,000/yr (USD) for one
  Care Manager

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Structure
Process
Outcomes
Donabedian Model for Outcomes Research
Care Management
Provider Characteristics
Providers Style And Practice Patterns
Job Satisfaction and Tenure
Care Delivery Model
Team Characteristics
Enactment of Roles
Resource Consumption
Patients and Families
Patient and Family Characteristics
Interpersonal Style and Social Support
Clinical End-Points Functional
Status Satisfaction
Multiple Dimensions of Outcomes Research
Design J.M. Clockey (2000). Critical Care Clinics
of North America, 14, 293-298.
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Third Generation Outcome Conceptual Framework
System Characteristics
Intervention
Outcome
Client Characteristics
Whitman, G. (2002). Outcomes Research. Critical
Care Nursing Clinics of North America, 14,
261-268.
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Care Coordination Outcomes

• Most research concentrates mainly on the
  financial outcomes
• Reduced length of stay
• Reduced Hospitalisations
• There is a lack of research about the other
  aspects
• Describing specifically what interventions work
• Describing how nursing interventions make a
  difference in care
• What client situations are best served by what
  model?

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Conclusion

• When reviewing Care Coordination literature, it
  is important to look at
• What exactly was the intervention
• Who did it?
• How long was it provided
• How was it provided in one setting or across
  settings?
• Who were the clients and how were they selected?