Linking quality and cost effectiveness: case management by an advanced practice nurse

Area of Science:

• Nursing
• Healthcare Management
• Surgical Outcomes

Background:

• Case management by advanced practice nurses (APNs) is a strategy to optimize patient care.
• Understanding the impact of APN case management on patient acuity and length of stay (LOS) is crucial for healthcare efficiency.
• Colon resection patients represent a significant surgical population where care coordination is vital.

Purpose of the Study:

• To examine the relationship between advanced practice nurse (APN) case management, patient acuity, and length of hospital stay (LOS) in patients undergoing colon resection.
• To determine if APN case management influences the predictive power of patient acuity on LOS.
• To identify potential benefits of APN involvement in surgical patient care pathways.

Main Methods:

• Retrospective chart review of 35 case-managed and 43 non-case-managed patients with colon resection.
• Comparison of mean patient acuity levels and mean LOS between the two groups.
• Regression analysis to assess the relationship between patient acuity and LOS within each group.

Main Results:

• Patients case managed by an APN had a trend toward higher acuity (8.36 vs. 7.78) and shorter LOS (11.51 vs. 12.35 days), though differences were not statistically significant.
• Patient acuity significantly predicted LOS in the non-case-managed group (p = 0.0145) but not in the APN case-managed group (p = 0.2812).
• APN case management appeared to negate acuity as a predictor of LOS.

Conclusions:

• Advanced practice nurse (APN) case management may alter the relationship between patient acuity and length of stay in colon resection patients.
• APN involvement shows a potential to mitigate the impact of higher patient acuity on hospital resource utilization.
• Further research is recommended to explore the association between APN case management and patient outcomes in surgical settings.