ADVANCING GERIATRIC NURSING PRACTICE: Randomized Controlled Trial of Nurse Case Management of Frail Older People

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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 (>70 years of age and at risk for repeated hospital admissions) discharged home from the emergency department.INTERVENTIONS: 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. J Am Geriatr Soc 47:1118–1124,1999.