title: Nurse care manager contribution to quality of care in a dual-eligible special needs plan.
abstract: We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults.
authors: RAND Health, Santa Monica, CA 90407, USA. roth@rand.org
authors: Carol P
authors: CP
authors: Roth
authors: David A
authors: DA
authors: Ganz
authors: Lorraine
authors: L
authors: Nickles
authors: David
authors: D
authors: Martin
authors: Robin
authors: R
authors: Beckman
authors: Neil S
authors: NS
authors: Wenger
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D003704:Dementia / Q000451:nursing; D003863:Depression / Q000175:diagnosis; D004608:Eligibility Determination; D006301:Health Services Needs and Demand; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000451:nursing; D006278:Medicare; D009729:Nursing; D010347:Patient Care Planning; D011787:Quality of Health Care; D013727:Terminal Care; D014481:United States; D014549:Urinary Incontinence / Q000451:nursing