title: Using high-intensity care management to integrate acute and long-term care services: substitute for large scale system reform?
abstract: This study evaluates a demonstration that used high intensity care management to improve integration between the acute and long-term care service systems. The demonstration intervention included the use of clinical nurse care manager, supervised by a geriatrician, to supplement an existing in-home care management system. Chronically disabled home care clients age 60 and over were randomly assigned (N = 308) to receive enhanced clinical services plus traditional care management, or to the control group, to receive the normal care management services provided. Treatment group members were expected to experience lower use of hospitals and nursing homes and lower overall health and long-term care costs. Research subjects were followed for up to 18 months using Medicare records and mortality data. A subsample (N = 150) also received in-person interviews to cover a range of health and social outcomes anticipated as a result of the intervention. Although there was some variation in health use and cost across treatment and control groups over the 18 month time period, the overall conclusion is that there were no differences between groups on any of the outcome variables examined. Efforts to integrate the acute and long-term care systems have proven to be difficult. This intervention, which attempted to create integration through high intensity care managers, but without financial or regulatory incentives, was simply unable to create enough change in the care system to produce significant change for the clients served.
authors.affiliation: Scripps Gerontology Center, Miami University, Oxford, OH 45056, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Applebaum
authors.forename: Jane
authors.initials: J
authors.lastname: Straker
authors.forename: Shahla
authors.initials: S
authors.lastname: Mehdizadeh
authors.forename: Gregg
authors.initials: G
authors.lastname: Warshaw
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gothelf
mesh_terms: D000368:Aged; D003152:Community Health Nursing / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D035061:Control Groups; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D008297:Male; D006278:Medicare; D009720:Nurse Clinicians; D009735:Nursing Homes / Q000706:statistics & numerical data; D010346:Patient Care Management; D017060:Patient Satisfaction; D010865:Pilot Projects; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology