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Keywords

case management/care management, chronic care model, lipid management, primary care teams

 

Authors

  1. Schraeder, Cheryl PhD, RN, FAAN
  2. Fraser, Cynthia MA
  3. Clark, Ida MSN, RN, APN/FPN
  4. Newcomer, Robert PhD
  5. Stoll, John MD
  6. Krock, Curtis MD
  7. Shelton, Paul EdD

ABSTRACT

Purpose: This article presents results of a randomized clinical trial evaluating the effectiveness of the Medicare Coordinated Care Demonstration, Illinois site, on selected clinical outcomes over 36 months.

 

Primary Practice Settings: Interdisciplinary teams, located at primary care practices, provided case and disease management services to 999 patients.

 

Results: Intervention group patients had higher lipids-testing rates during the first 2 years than control group patients. Once tested, more than 80% of patients in both groups were retested in subsequent years. There were no differences in the percentage of intervention group patients who were in low-density lipoprotein cholesterol (LDL-C) control at program entry and at the end of 36 months as compared with control group patients (maintained control). However, a higher percentage of intervention group patients who were not in the LDL-C control at baseline were in control after 36 months as compared with control group patients (achieved control).

 

Implications for Case Management Practice: This study suggests that physician-nurse case management team care has the potential to augment the effectiveness of primary care by increasing adherence to testing protocols among elderly patients with multiple chronic illnesses, but this effect diminishes over time as guidelines are adopted into general practice. It suggests that LDL-C therapeutic control can be improved through increased lipids testing and the use of lipid-lowering medications. The results also indicate that care management strategies targeting more intensive patients versus less intensive patients are cost-effective strategies that can be expanded beyond lipids testing and control to other clinical health status measures.