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J Clin Outcomes Manage
2010 May;17(5):209-215
Nurse care coordination of older patients in an academic family medicine clinic: 5-year outcomes
Kruse RL, Zweig SC, Nikodim B, LeMaster JW, Coverly JS, Colwill JM
Abstract Objective: To evaluate the impact of a nurse care coordinator in a family medicine clinic. Methods: We identified patients aged 65 years and older who had been seen at least 3 times by a family medicine outpatient team during 1998. These patients (intervention group) received care coordination by a nurse partner and were matched 1:2 with patients who had 3 or more outpatient visits with another clinic team during 1998. We followed both groups for up to 5 years. Outcomes included number of outpatient, emergency department (ED), and urgent care visits, inpatient stays, and observation stays. We also performed a death certificate search. We examined mortality with survival analysis and compared the 2 groups’ other outcomes with Poisson and negative binomial regression. Results: There were 130 patients in the intervention group and 249 controls. After adjusting for age and sex, participants in the intervention group had fewer ED visits (0.71/1000 patient-days) than the control group (1.04/1000 patient-days; P = 0.034) and fewer urgent care visits (0.17/1000 patient-days vs. 0.43/1000 patient-days for controls; P < 0.001). There was no difference between groups for other measures, including mortality. Conclusion: Care coordination in a U.S. primary care clinic by a nurse partner reduced emergent and urgent visits without increasing primary care or physician specialty visits. There was no reduction in use of inpatient services or mortality. While the program benefits patients and payors, there is currently no mechanism for supporting it in a fee-for-service system.
Original Research
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