Randomized controlled trial of nurse case management of frail older people

Author(s): Schein, C., McVey, L., Bergman, H.

Journal/Book: J Amer Geriat Soc. 1999; 47: 227 East Washington Sq, Philadelphia, PA 19106, USA. Lippincott Williams & Wilkins. 1118-1124.

Abstract: OBJECTIVES: To compare the effects of nurse case management with usual care provided to community-dwelling frail older people in regard to quality of life, satisfaction with care, functional status, admission to hospital, length of hospital stay, and readmission to emergency department. DESIGN: Randomized controlled trial. SETTING: University hospital and two proximal community health centers. PARTICIPANTS: 427 frail older people (greater than or equal to 70 years of age and at risk for repeated hospital admissions) discharged home from the emergency department. INTERVENTIONS: Experimental: Nurse case management, which consisted of coordination and provision of healthcare services by nurses, both in and out of hospital, for a 10-month period. Control: Usual care, which varied by healthcare provider and community health center. MEASUREMENTS: Outcomes were assessed 10 months post-randomization by telephone and/or home interview and by medical record review. Questionnaires included the SF36(R), CSQ-8, and OARS. RESULTS: No significant differences were found in quality of life, satisfaction with care, functional status, admission to hospital, or length of hospital stay. Nurse-case-managed older adults were readmitted to the emergency department significantly more often than their usual care counterparts. CONCLUSIONS: Frail older people receiving nurse case management are more likely to use emergency health services without a concomitant increase in health benefits.

Note: Article Gagnon AJ, Sir Mortimer B Davis Jewish Hosp, Ctr Nursing Res, A-811, 3755 Chemin Cote Ste, Montreal, PQ H3T 1E2, CANADA

Keyword(s): nursing; intervention studies; aged; ELDERLY PEOPLE; HOME; INTERVENTION; VALIDITY

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