Dataset Information

Cost analysis of a home-based nurse care coordination program.

ABSTRACT:

Objectives

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.

Design

Randomized, controlled, three-arm longitudinal study.

Setting

Participant homes in a large Midwestern urban area.

Participants

Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414).

Intervention

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.

Measurements

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.

Conclusion

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.

SUBMITTER: Marek KD

PROVIDER: S-EPMC4383646 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Publications

Cost analysis of a home-based nurse care coordination program.

Marek Karen Dorman KD Stetzer Frank F Adams Scott J SJ Bub Linda Denison LD Schlidt Andrea A Colorafi Karen Jiggins KJ

Journal of the American Geriatrics Society 20141208 12

<h4>Objectives</h4>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.<h4>Design</h4>Randomized, controlled, three-arm longitudinal study.<h4>Setting</h4>Participant homes in a large Midwestern urban area.<h4>Participants</h4>Older adults identified as having difficulty managing their medications at ...[more]

PMID: 25482242

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Project description:BACKGROUND: Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. METHODS: General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient's depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. RESULTS: Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. CONCLUSIONS: Classification of patients' depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement.

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Dataset Information

Cost analysis of a home-based nurse care coordination program.

Objectives

Design

Setting

Participants

Intervention

Measurements

Results

Conclusion

Publications

Cost analysis of a home-based nurse care coordination program.

Similar Datasets

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