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Randomized controlled trial of nurse case management of frail older people
A J Gagnon1, C Schein, L McVey
1Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.
Objectives:
To compare the effects of nurse case management with usual care provided to community-dwelling frail older people in regard to quality of life, satisfaction with care, functional status, admission to hospital, length of hospital stay, and readmission to emergency department.
Design:
Randomized controlled trial.
Setting:
University hospital and two proximal community health centers.
Participants:
427 frail older people (> or = 70 years of age and at risk for repeated hospital admissions) discharged home from the emergency department.
Experimental:
Nurse case management, which consisted of coordination and provision of healthcare services by nurses, both in and out of hospital, for a 10-month period.
Control:
Usual care, which varied by healthcare provider and community health center.
Measurements:
Outcomes were assessed 10 months post-randomization by telephone and/or home interview and by medical record review. Questionnaires included the SF-36, CSQ-8, and OARS.
Results:
No significant differences were found in quality of life, satisfaction with care, functional status, admission to hospital, or length of hospital stay. Nurse-case-managed older adults were readmitted to the emergency department significantly more often than their usual care counterparts.
Conclusions:
Frail older people receiving nurse case management are more likely to use emergency health services without a concomitant increase in health benefits.