Large-scale, three-year Utah study shows that chronically ill seniors benefit significantly when their care is proactively managed by multidisciplinary teams supported by dynamic electronic tracking and care coordination tools.
Can a patient-centered care management program utilizing nurse care managers, supported by electronic tracking and care coordination reduce the rate of deaths and hospitalizations among chronically ill older adults? The answer — based on a three-year study involving more than 3,400 chronically ill seniors in Utah — appears to be yes, accompanied with significant costs savings.
The study — published in the Journal of the American Geriatrics Society — has broad implications for the more than 130 million Americans with chronic illnesses, two thirds of who are 65 or older. In the study, physicians referred patients with complex conditions to nurse care managers, who created detailed care plans that were supported by a care management tracking database, a specialized computer tool. Dr. Linda Leckman, the CEO of the Medical Group comments: "The combination of Intermountain's well-developed care guidelines, the tracking database and expertly trained nurses and doctors are the key to improved care for people who have multiple medical conditions such as diabetes."
The longitudinal study — conducted between 2002 and 2005 at 13 Intermountain Healthcare clinics — found that deaths among the patients in the "intervention" group receiving Care Management Plus (CMP), were significantly lower.
For example, patients who received care management for diabetes or other illnesses showed a reduction in death of over six percent after one year in the study, compared to patients receiving usual care who experienced a death rate of about 11 percent.
Hospitalizations were only slightly lower overall for CMP patients; however, hospitalizations for diabetes patients in the CMP group were significantly lower at 21 percent versus 26 percent for other patients at one year, and 30 percent for the CMP group versus 39 percent at two years into the study.
Dr. David Dorr, researcher and principal author states, "When calculated into potential savings, this can amount up to $70,000 in avoidable medical costs per clinic for patients. If applied broadly, the savings could amount to billions of dollars of reduced medical costs nationally." Dorr is an assistant professor at Oregon Health & Science University in Portland, Oregon.
Brunker, chief of Geriatrics at LDS Hospital and an assistant professor at the University of Utah School of Medicine, developed the geriatrics training for the nurse care managers, and in partnership with Dr. Dorr is working to teach other healthcare systems, doctors and nurses about Care Management Plus in Utah and nationally.
Care Manager programs have been expanded to numerous other Intermountain Healthcare clinics.
Intermountain Healthcare is a community-owned system of nonprofit hospitals and clinics that provides medical care to residents of Utah and Idaho. Intermountain's physicians, nurses and other caregivers are recognized national leaders in providing high quality care, regardless of patients' ability to pay.
The John A. Hartford Foundation supported the development and study of Care Management Plus and its current dissemination. Founded in 1929, the John A. Hartford Foundation is a committed champion of training, research and service system innovations that promote the health and independence of America's older adults. Through its grant making, the Foundation seeks to strengthen the nation's capacity to provide effective, affordable care to this rapidly increasing older population by educating "aging-prepared" health professionals (physicians, nurses, social workers), and developing innovations that improve and better integrate health and supportive services. The Foundation was established by John A. Hartford. Mr. Hartford and his brother, George L. Hartford, both former chief executives of the Great Atlantic & Pacific Tea Company, left the bulk of their estates to the Foundation upon their deaths in the 1950s. Additional information about the Foundation and it programs is available on its website, at: www.jhartfound.org