Work

Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions

Year: 2013

Type: article

Abstract: OBJECTIVES: To determine whether community-based primary care physician (PCP)-nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)-2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions. DESIGN: Case study. SETTING: Two community-based primary care practices. PARTICIPANTS: Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression. INTERVENTION: The ACOVE-2 model augmented by NP comanagement of conditions. MEASUREMENTS: Quality of care according to medical record review using ACOVE-3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices. RESULTS: Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P < .001), as did NP estimate of medical management style (P = .02). CONCLUSION: NP comanagement is associated with better quality of care for geriatric conditions in community-based primary care than usual care using the ACOVE-2 model.

Source: Journal of the American Geriatrics Society

DOI: 10.1111/jgs.12268

Authors: David B. Reuben, David A. Ganz, Carol P. Roth, Heather E. McCreath, Karina D. Ramirez, Neil S. Wenger

Institutions: University of California, Los Angeles, RAND Corporation, VA Greater Los Angeles Healthcare System

Language: English

Topic: Nursing Roles and Practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Institute on Aging