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Elderly patients hospitalized for heart failure who receive specialized care coordinated by an advanced practice nurse (APN) have a better quality of life, according to a new study from the National Institute of Nursing Research. Specialized nursing care both during the patients' hospital stays and at home following discharge also resulted in fewer hospital readmissions and a 38% savings in Medicare costs.


In the study, 239 patients ages 65 and older diagnosed with heart failure received either standard care or care that was coordinated by an APN. The APNs participating in the study had received special instruction about educational and behavioral strategies to help patients avoid complications and other problems.


An APN visited a patient in the test group within 24 hours of his admission and coordinated the care given by his health care team, including physicians, nurses, pharmacists, and social workers. She also visited the patient at his home within 24 hours of discharge, remained available to him by telephone, and followed up with him for 1 year after hospital discharge.


Researchers found that patients who received care from APNs had a better quality of life 1 year after their discharge and had fewer hospital readmissions.


The increased level of care cost nearly twice as much as standard care. But because the number of hospital readmissions dropped, the higher level of care saved about $4,845 per patient over 12 months. Based on these findings, a major health insurer has launched a $1 million pilot program to test the research in practice in New Jersey, Delaware, and Pennsylvania.




"Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial," Journal of the American Geriatrics Society, M. Naylor, et al., May 2004.