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Nurse Care Coordination in Community-Based Long-Term Care

Authors

  • Karen Dorman Marek,

    1. Karen Dorman Marek, RN, MBA, PhD, FAAN, Eta Nu, Associate Professor, University of Wisconsin-Milwaukee, Milwaukee, WI; Lori Popejoy, MSN, APRN, BC, GCNS, Alpha Iota, John A. Hartford Building Academic Geriatric Nursing Capacity Scholar, Research Coordinator, Boone Hospital Center, Columbia, MO; Greg Petroski, PhD, Statistician, Office of Medical Research, School of Medicine; Marilyn Rantz, RN, PhD, FAAN, Alpha Iota, Professor, Sinclair School of Nursing and Family and Community Medicine; both at University of Missouri-Columbia, Columbia, MO. This research was supported in part by grants from the Centers for Medicaid and Medicare Services, Grant 18-C-91036, University of Iowa Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Research, and the Robert Wood Johnson Executive Nurse Fellows Program 2000 Cohort. Correspondence to Dr. Marek, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. E-mail: kmarek@uwm.edu
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  • Lori Popejoy,

    1. Karen Dorman Marek, RN, MBA, PhD, FAAN, Eta Nu, Associate Professor, University of Wisconsin-Milwaukee, Milwaukee, WI; Lori Popejoy, MSN, APRN, BC, GCNS, Alpha Iota, John A. Hartford Building Academic Geriatric Nursing Capacity Scholar, Research Coordinator, Boone Hospital Center, Columbia, MO; Greg Petroski, PhD, Statistician, Office of Medical Research, School of Medicine; Marilyn Rantz, RN, PhD, FAAN, Alpha Iota, Professor, Sinclair School of Nursing and Family and Community Medicine; both at University of Missouri-Columbia, Columbia, MO. This research was supported in part by grants from the Centers for Medicaid and Medicare Services, Grant 18-C-91036, University of Iowa Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Research, and the Robert Wood Johnson Executive Nurse Fellows Program 2000 Cohort. Correspondence to Dr. Marek, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. E-mail: kmarek@uwm.edu
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  • Greg Petroski,

    1. Karen Dorman Marek, RN, MBA, PhD, FAAN, Eta Nu, Associate Professor, University of Wisconsin-Milwaukee, Milwaukee, WI; Lori Popejoy, MSN, APRN, BC, GCNS, Alpha Iota, John A. Hartford Building Academic Geriatric Nursing Capacity Scholar, Research Coordinator, Boone Hospital Center, Columbia, MO; Greg Petroski, PhD, Statistician, Office of Medical Research, School of Medicine; Marilyn Rantz, RN, PhD, FAAN, Alpha Iota, Professor, Sinclair School of Nursing and Family and Community Medicine; both at University of Missouri-Columbia, Columbia, MO. This research was supported in part by grants from the Centers for Medicaid and Medicare Services, Grant 18-C-91036, University of Iowa Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Research, and the Robert Wood Johnson Executive Nurse Fellows Program 2000 Cohort. Correspondence to Dr. Marek, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. E-mail: kmarek@uwm.edu
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  • Marilyn Rantz

    1. Karen Dorman Marek, RN, MBA, PhD, FAAN, Eta Nu, Associate Professor, University of Wisconsin-Milwaukee, Milwaukee, WI; Lori Popejoy, MSN, APRN, BC, GCNS, Alpha Iota, John A. Hartford Building Academic Geriatric Nursing Capacity Scholar, Research Coordinator, Boone Hospital Center, Columbia, MO; Greg Petroski, PhD, Statistician, Office of Medical Research, School of Medicine; Marilyn Rantz, RN, PhD, FAAN, Alpha Iota, Professor, Sinclair School of Nursing and Family and Community Medicine; both at University of Missouri-Columbia, Columbia, MO. This research was supported in part by grants from the Centers for Medicaid and Medicare Services, Grant 18-C-91036, University of Iowa Gerontological Nursing Interventions Research Center and the Hartford Center for Geriatric Research, and the Robert Wood Johnson Executive Nurse Fellows Program 2000 Cohort. Correspondence to Dr. Marek, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. E-mail: kmarek@uwm.edu
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Abstract

Purpose: To evaluate the clinical outcomes of a nurse care coordination program for people receiving services from a state-funded home and community-based waiver program called Missouri Care Options (MCO).

Design: A quasi-experimental design was used to compare 55 MCO clients who received nurse care coordination (NCC) and 30 clients who received MCO services but no nurse care coordination.

Methods: Nurse care coordination consists of the assignment of a registered nurse who provides home care services for both the MCO program and Medicare home health services. Two standardized datasets, the Minimum Data Set (MDS) for resident care and planning and the Outcome Assessment Instrument and Data Set (OASIS) were collected at baseline, 6 months, and 12 months on both groups. Cognition was measured with the MDS Cognitive Performance Scale (CPS), activities of daily living (ADL) as the sum of five MDS ADL items, depression with the MDS-Depression Rating Scale, and incontinence and pressure ulcers with specific MDS items. Three OASIS items were used to measure pain, dyspnea, and medication management. The Cochran-Mantel-Haenszel (CMH) method was used to test the association between the NCC intervention and clinical outcomes.

Findings: At 12 months the NCC group scored significantly better statistically in the clinical outcomes of pain, dyspnea, and ADLs. No significant differences between groups were found in eight clinical outcome measures at 6 months.

Conclusions: Use of nurse care coordination for acute and chronic home care warrants further evaluation as a treatment approach for chronically ill older adults.

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