title: Nurse practitioner comanagement for patients in an academic geriatric practice.
abstract: OBJECTIVE
  To determine whether nurse practitioner (NP) comanagement can improve the quality of care for 5 chronic conditions in an academic geriatrics practice.
  
  
  METHODS
  From September 2006 to September 2007, 18 primary care geriatricians were divided into an intervention group that could refer patients to an NP for comanagement of dementia, depression, falls, heart failure, and/or urinary incontinence, or a control group that indicated which patients would have been referred to the NP for these conditions. The NP used structured visit notes to guide care delivery for the 5 conditions concordant with Assessing Care of Vulnerable Elders-3 (ACOVE-3) quality indicators. We reviewed charts to determine adherence to recommended processes of care.
  
  
  RESULTS
  A total of 200 patients (108 intervention, 92 control) were eligible for at least 1 process of care recommended by ACOVE-3 for the 5 conditions. Patients' mean (SD) age was 85 years (7 years), 67% were women, and patients were eligible for a mean (SD) of 6.9 (4.4) processes of care. Intervention patients were eligible for more care processes than controls (7.8 vs 5.9 processes per patient; P = .002). Quality of care was higher for patients in the intervention group compared with the control group (54% vs 34% of care processes completed; P <.001). The adjusted absolute difference between intervention and control groups in care processes completed was 20% (95% confidence interval = 13%, 27%).
  
  
  CONCLUSIONS
  NP comanagement of 5 chronic conditions was associated with higher quality of care, even in a practice of geriatricians.
authors.affiliation: Division of Geriatric Medicine and Gerontology, University of California, Los Angeles, 11301 Wilshire Blvd, Bldg 220, Rm 313 (11G), Los Angeles, CA 90073, USA. dganz@mednet.ucla.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Koretz
authors.forename: Julia K
authors.initials: JK
authors.lastname: Bail
authors.forename: Heather E
authors.initials: HE
authors.lastname: McCreath
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Carol P
authors.initials: CP
authors.lastname: Roth
authors.forename: David B
authors.initials: DB
authors.lastname: Reuben
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D002908:Chronic Disease; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D003863:Depression / Q000451:nursing* / Q000523:psychology; D005260:Female; D005851:Geriatric Nursing; D006333:Heart Failure / Q000451:nursing* / Q000523:psychology; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011787:Quality of Health Care; D013223:Statistics as Topic; D014549:Urinary Incontinence / Q000451:nursing* / Q000523:psychology