Effect of a nurse case manager on postdischarge follow-up.
OBJECTIVE
To examine whether use of a nurse case manager to coordinate postdischarge care would improve rates of follow-up, emergency department utilization, and unexpected readmission for general medicine patients.


METHODS
Prospective cohort trial.


METHODS
Publicly supported, tertiary-care teaching hospital.


METHODS
Four hundred seventy-eight patients admitted to the general medicine service.


METHODS
Use of a nurse case manager to provide discharge planning before hospital discharge and to arrange for postdischarge outpatient follow-up. Patients in the control group had discharge planning in the traditional ("usual care") manner.


RESULTS
The proportion of patients with scheduled outpatient appointments in the medical clinic and the proportion making clinic visits, emergency department visits, or with readmission to the hospital within 30 days following discharge. A significantly greater proportion of patients assigned to the nurse case manager intervention had appointments scheduled at the time of hospital discharge (63% vs 46%, p < .001), and made scheduled visits in the outpatient clinic (32% vs 23%, p < .03). Intervention group patients were especially more likely than control group patients to have definite follow-up appointments if they were discharged on weekends. Intervention and control group patients did not differ, however, in the rates of emergency department utilization (p = .52) or unexpected readmissions within 30 days of discharge (p = .11).


CONCLUSIONS
Use of a nurse case manager to coordinate outpatient follow-up prior to discharge improved the continuity of outpatient care for patients on a general medical service. The intervention had no effect on unexpected readmissions or emergency department utilization.
Einstadter
D
D
Division of General Internal Medicine, Case Western Reserve University and the MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
Cebul
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RD
Franta
P R
PR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001071:Appointments and Schedules; D019090:Case Management; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D009819:Office Visits; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies