title: Cost analysis of a home-based nurse care coordination program.
abstract: OBJECTIVE
  To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost.
  
  
  METHODS
  Randomized, controlled, three-arm longitudinal study.
  
  
  METHODS
  Participant homes in a large Midwestern urban area.
  
  
  METHODS
  Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414).
  
  
  METHODS
  A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group.
  
  
  METHODS
  To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files.
  
  
  RESULTS
  Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group.
  
  
  CONCLUSIONS
  Nurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention.
authors.affiliation: College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.
authors.forename: Karen Dorman
authors.initials: KD
authors.lastname: Marek
authors.forename: Frank
authors.initials: F
authors.lastname: Stetzer
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Adams
authors.forename: Linda Denison
authors.initials: LD
authors.lastname: Bub
authors.forename: Andrea
authors.initials: A
authors.lastname: Schlidt
authors.forename: Karen Jiggins
authors.initials: KJ
authors.lastname: Colorafi
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D003365:Costs and Cost Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012648:Self Care; D014481:United States; D014922:Wisconsin
chemical_list: D004364:Pharmaceutical Preparations
keywords: care coordination; cost effectiveness; self-management