Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled Trial
Background:
Improving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment.
Methods and Findings:
HQP enrolled 1,736 adults aged 65 and over, with one or more eligible chronic conditions (coronary artery disease, heart failure, diabetes, asthma, hypertension, or hyperlipidemia) during the first six years of the study. The intervention group (n = 873) was offered a comprehensive, integrated, and tightly managed system of care coordination, disease management, and preventive services provided by community-based nurse care managers working collaboratively with primary care providers. The control group (n = 863) received usual care. Overall, a 25% lower relative risk of death (hazard ratio [HR] 0.75 [95% CI 0.57–1.00], p = 0.047) was observed among intervention participants with 86 (9.9%) deaths in the intervention group and 111 (12.9%) deaths in the control group during a mean follow-up of 4.2 years. When covariates for sex, age group, primary diagnosis, perceived health, number of medications taken, hospital stays in the past 6 months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55–0.98, p = 0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events were identified.
Conclusions:
The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. Limitations of the study are that few low-income and non-white individuals were enrolled and implementation was in a single geographic region of the US. Additional research to confirm these findings and determine the model's scalability and generalizability is warranted.
Trial Registration: ClinicalTrials.gov NCT01071967
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled Trial. PLoS Med 9(7): e32767. doi:10.1371/journal.pmed.1001265
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001265
Souhrn
Background:
Improving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment.
Methods and Findings:
HQP enrolled 1,736 adults aged 65 and over, with one or more eligible chronic conditions (coronary artery disease, heart failure, diabetes, asthma, hypertension, or hyperlipidemia) during the first six years of the study. The intervention group (n = 873) was offered a comprehensive, integrated, and tightly managed system of care coordination, disease management, and preventive services provided by community-based nurse care managers working collaboratively with primary care providers. The control group (n = 863) received usual care. Overall, a 25% lower relative risk of death (hazard ratio [HR] 0.75 [95% CI 0.57–1.00], p = 0.047) was observed among intervention participants with 86 (9.9%) deaths in the intervention group and 111 (12.9%) deaths in the control group during a mean follow-up of 4.2 years. When covariates for sex, age group, primary diagnosis, perceived health, number of medications taken, hospital stays in the past 6 months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55–0.98, p = 0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events were identified.
Conclusions:
The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. Limitations of the study are that few low-income and non-white individuals were enrolled and implementation was in a single geographic region of the US. Additional research to confirm these findings and determine the model's scalability and generalizability is warranted.
Trial Registration: ClinicalTrials.gov NCT01071967
: Please see later in the article for the Editors' Summary
Zdroje
1. PhamHHSchragDO'MalleyASWuBBachPB 2007 Care patterns in medicare and their implications for pay for performance. N Engl J Med 356 1130 1139
2. PhamHHO'MalleyASBachPBSaiontz-MartinezCSchragD 2009 Primary care physicians' links to other physicians through medicare patients: the scope of care coordination. Ann Intern Med 150 236 242
3. JencksSFWilliamsMVColemanEA 2009 Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360 1418 1428
4. McGlynnEAAschSMAdamsJKeeseyJHicksJ 2003 The quality of health care delivered to adults in the United States. N Engl J Med 348 2635 2645
5. CBO 2005 High-cost medicare beneficiaries Washington (D.C.) US Congressional Budget Office Paper Available: http://www.cbo.gov/publication/16487. Accessed 06/06/2012
6. MedPac 2007 Report to Congress: promoting greater efficiency in Medicare. MedPac Report to Congress June 2007. Chapter 1: 3–26. Available: http://www.medpac.gov/documents/Jun07_EntireReport.pdf. Accessed 06/06/2012
7. LopezAMathersCEzzatiMJamisonDMurrayC 2006 Global burden of disease and risk factors New York The World Bank and Oxford University Press
8. AlwanA 2011 Global status report on noncommunicable diseases 2010 Geneva World Health Organization (QHO) Available: http://whqlibdoc.who.int/publications/2011/9789240686458_eng.pdf. Accessed 06/06/2012
9. IOM 2003 Priority areas for national action: transforming health care quality Rockville (Maryland) Agency for Healthcare Research and Quality Available: http://www.ahrq.gov/qual/iompriorities.htm. Accessed 06/06/2012
10. SchultzAMMcGinnisJM Rapporteurs; Institute of Medicine 2009 Integrative medicine and the health of the public: a summary of the February 2009 Summit Washington (D.C.) National Academy Press 250
11. BodenheimerT 2008 Coordinating care – a perilous journey through the health care system. N Engl J Med 358 1064 1071
12. CantRPFosterMM 2011 Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care. Aust Health Rev 35 468 474
13. WilsonPMBrooksFProcterSKendallS 2012 The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales. Int J Nurs Stud 49 2 14
14. DouglasKAYenLEKordaRJKljakovicMGlasgowNJ 2011 Chronic disease management items in general practice: a population-based study of variation in claims by claimant characteristics. Med J Aust 195 198 202
15. MayCRFinchTLCornfordJExleyCGatelyC 2011 Integrating telecare for chronic disease management in the community: what needs to be done? BMC Health Serv Res 11 131
16. GriffithsPMabenJMurrellsT 2011 Organisational quality, nurse staffing and the quality of chronic disease management in primary care: observational study using routinely collected data. Int J Nurs Stud 48 1199 1210
17. LupariMCoatesVAdamsonGCrealeyGE 2011 ‘We're just not getting it right’–how should we provide care to the older person with multi-morbid chronic conditions? J Clin Nurs 20 1225 1235
18. CandyBTaylorSJCRamsayJEsmondGGriffithsCJ 2007 Service implications from a comparison of the evidence on the effectiveness and a survey of provision in England and Wales of COPD specialist nurse services in the community. Int J Nurs Stud 44 601 610
19. CheahJ 2001 Chronic disease management: a Singapore perspective. BMJ 323 990 993
20. BottDMKappMCJohnsonLBMagnoLM 2009 Disease management for chronically ill beneficiaries in traditional Medicare. Health Aff (Millwood) 28 86 98
21. DrabikABuscherGSawickiPTThomasKGrafC 2012 Life prolonging of disease management programs in patients with type 2 diabetes is cost-effective. Diabetes Res Clin Pract 95 194 200
22. LoweryJHoppFSubramanianUWiitalaWWelshDE 2012 Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study. Congest Heart Fail 18 64 71
23. BischoffAEkoeTPeroneNSlamaSLoutanL 2009 Chronic disease management in Sub-Saharan Africa: whose business is it? Int J Environ Res Public Health 6 2258 2270
24. LekoubouAAwahPFezeuLSobngwiEKengneAP 2010 Hypertension, diabetes mellitus and task shifting in their management in sub-Saharan Africa. Int J Environ Res Public Health 7 353 363
25. Centers for Medicare and Medicaid Services US 2011 Medicare Coordinated Care Demonstration information webpage. Available http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/Medicare-Demonstrations-Items/CMS1198864.html. Accessed 06/06/2012
26. BrownRPeikesDChenANgJSchoreJ 2007 The evaluation of the Medicare coordinated care demonstration: findings for the first two years Princeton (New Jersey) Mathematica Policy Research, Inc Available: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Downloads/Brown.pdf. Accessed 06/06/2012
27. PeikesDChenASchoreJBrownR 2009 Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA 301 603 618
28. PeikesDBrownRChenASchoreJ 2008 Third report to Congress on the evaluation of the Medicare Coordinated Care Demonstration Princeton (New Jersey) Mathematica Policy Research, Inc MPR reference number 8756-430. Available: http://www.mathematica-mpr.com/publications/PDFs/health/MCCD_rptcongress08.pdf. Accessed 06/06/2012
29. SchoreJPeikesDPetersonGGerolamoABrownR 2011 Fourth report to Congress on the evaluation of the Medicare Coordinated Care Demonstration Princeton (New Jersey) Mathematica Policy Research, Inc Available: https://www.cms.gov/reports/downloads/Schore_Fourth_Eval_MCCD_March_2011.pdf. Accessed 06/06/2012 24
30. BrownRSAliottaSArchibaldNChenAPeikesD 2001 Research design for the evaluation of the Medicare Coordinated Care Demonstration. Available: http://www.mathematica-mpr.com/publications/PDFs/researchdesign.pdf. Accessed 06/06/2012 181
31. ArchibaldNSchoreJ 2003 The early experience of the Health Quality Partners case management program Princeton (New Jersey) Mathematica Policy Research, Inc MPR reference number 8756-310. Available; http://www.mathematica-mpr.com/publications/PDFs/healthqualitypartnersearly.pdf. Accessed 06/06/2012
32. Phillips-HarrisC 1996 The integration of primary care and case management in chronic disease. Qual Manag Health Care 5 1 6
33. Phillips-HarrisC 1998 Case management: high-intensity care for frail patients with complex needs. Geriatrics 53 62 64, 67–68; quiz 69
34. FixsenDLBlaseKANaoomSFWallaceF 2009 Core implementation components. Res Social Work Prac 19 531 540
35. VetterNJJonesDAVictorCR 1984 Effect of health visitors working with elderly patients in general practice: a randomised controlled trial. Br Med J (Clin Res Ed) 288 369 372
36. HendriksenCLundEStrømgårdE 1984 Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J (Clin Res Ed) 289 1522 1524
37. Pathy, BayerAHardingKDibbleA 1992 Randomised trial of case finding and surveillance of elderly people at home. Lancet 340 890 893
38. VetterNJLewisPAFordD 1992 Can health visitors prevent fractures in elderly people? BMJ 304 888 890
39. LeffBReiderLFrickKDScharfsteinDOBoydCM 2009 Guided care and the cost of complex healthcare: a preliminary report. Am J Manag Care 15 555 559
40. BoultCReiderLFreyKLeffBBoydCM 2008 Multidimensional geriatric assessment: back to the future early effects of “guided care” on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci 63 321 327
41. BoydCMShadmiEConwellLJGriswoldMLeffB 2008 A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med 23 536 542
42. CounsellSRCallahanCMTuWStumpTEArlingGW 2009 Cost analysis of the geriatric resources for assessment and care of elders care management intervention. J Am Geriatr Soc 57 1420 1426
43. CounsellSRCallahanCMClarkDOTuWButtarAB 2007 Geriatric care management for low-income seniors: a randomized controlled trial. JAMA 298 2623 2633
44. StockRMahoneyERReeceDCesarioL 2008 Developing a senior healthcare practice using the chronic care model: effect on physical function and health-related quality of Life. J Am Geriatr Soc 56 1342 1348
45. ColemanKAustinBTBrachCWagnerEH 2009 Evidence on the chronic care model in the new millennium. Health Aff (Millwood) 28 75 85
46. ColemanKMattkeSPerraultPJWagnerEH 2009 Untangling practice redesign from disease management: how do we best care for the chronically ill? Annu Rev Public Health 30 385 408
47. NaylorMDBrootenDCampbellRJacobsenBSMezeyMD 1999 Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 281 613 620
48. NaylorMDBrootenDACampbellRLMaislinGMcCauleyKM 2004 Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc 52 675 684
49. ColemanEAParryCChalmersSMinSJ 2006 The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 166 1822 1828
50. ColemanEASmithJDFrankJCMinSJParryC 2004 Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc 52 1817 1825
51. CohenHJFeussnerJRWeinbergerMCarnesMHamdyRC 2002 A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 346 905 912
52. BoultCReiderLLeffBFrickKDBoydCM 2011 The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Arch Intern Med 171 460 466
53. McCallNCromwellJ 2011 Results of the Medicare Health Support disease-management pilot program. N Engl J Med 365 1704 1712
54. SchraederCSheltonPSagerM 2001 The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults. J Gerontol A Biol Sci Med Sci 56 M106 M112
55. DorrDAWilcoxABBrunkerCPBurdonREDonnellySM 2008 The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. J Am Geriatr Soc 56 2195 2202
56. PhillipsLSBranchWTCookCBDoyleJPEl-KebbiIM 2001 Clinical inertia. Ann Intern Med 135 825 834
57. HingEBurtCW 2007 Characteristics of office-based physicians and their practices: United States, 2003–04. Vital Health Stat 13 1 34
58. RittenhouseDRCasalinoLPShortellSMMcClellanSRGilliesRR 2011 Small and medium-size physician practices use few patient-centered medical home processes. Health Aff (Millwood) 30 1575 1584
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2012 Číslo 7
- Mobilní aplikace jako nová možnost v prevenci napadení klíštětem
- Hydroresponzivní krytí v epitelizační fázi hojení rány
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Vztah mezi statiny a rizikem vzniku nádorových onemocnění − metaanalýza
- Metabolit živočišné stravy produkovaný střevní mikroflórou zvyšuje riziko závažných kardiovaskulárních příhod
Najčítanejšie v tomto čísle
- HIV Treatment as Prevention: Issues in Economic Evaluation
- HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes
- Reduction in Infection Rates after Mandatory Hospital Public Reporting: Findings from a Longitudinal Cohort Study in Canada
- Medical Device Regulation: Time to Improve Performance