Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions

Authors

  • David B. Reuben MD,

    Corresponding author
    • Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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  • David A. Ganz MD, PhD,

    1. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
    2. Health Services Research and Development Center of Excellence and Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
    3. RAND Health, Santa Monica, CA
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  • Carol P. Roth RN, MPH,

    1. RAND Health, Santa Monica, CA
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  • Heather E. McCreath PhD,

    1. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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  • Karina D. Ramirez BA,

    1. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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  • Neil S. Wenger MD, MPH

    1. RAND Health, Santa Monica, CA
    2. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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  • [Editorial comments by Barbara Resnick, PhD, CRNP, FAAN, AGSF pp 1019–1021]

Address correspondence to David B. Reuben, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA 90095. E-mail: dreuben@mednet.ucla.edu

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.

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