Randomized controlled trial of nurse case management of frail older people

Abstract

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.