| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| ||||||||||||||||||||||||||||||||
Correspondence: Address correspondence to Robert L. Kane, MD, University of Minnesota School of Public Health, D351 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: kanex001{at}umn.edu
Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will reduce the rate of untoward events and reduce the use of hospitals. Four aspects of quality were assessed: mortality, preventable hospitalizations, quality indicators derived from the Minimum Data Set, and change in functioning. Design and Methods: The care provided by Evercare was compared with that for two control groups: (a) other residents in the same homes not enrolled in Evercare and (b) residents in homes in the same geographic area that did not participate in Evercare. Data came from various sources, including the Minimum Data Set. Utilization was based on Medicare data for controls and United Healthcare data for Evercare residents. Survival analysis was used to estimate mortality rates. Various risk adjustment methods were applied to the quality indicators. Results: The hazard rates of mortality were significantly lower for Evercare residents than for other residents in the same nursing homes. Evercare residents had fewer preventable hospitalizations; the difference was significant for one control group. The rates of quality indicators and functional change were equivalent. Implications: Evercare, with its use of nurse practitioners, represents a model that can provide more efficient care that is of at least comparable quality.
Key Words: Nurse practitioner • Preventable hospitalization • Quality indicators • Managed care
This article has been cited by other articles:
 |
|
 |
|
  I. P. Donald, J. Gladman, S. Conroy, M. Vernon, E. Kendrick, and E. Burns Care home medicine in the UK--in from the cold Age Ageing, November 1, 2008; 37(6): 618 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Arling, R. L. Kane, C. Mueller, J. Bershadsky, and H. B. Degenholtz Nursing Effort and Quality of Care for Nursing Home Residents Gerontologist, October 1, 2007; 47(5): 672 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Bravo, M.-F. Dubois, and P.-M. Roy Using goal attainment scaling to improve the quality of long-term care: a group-randomized trial Int. J. Qual. Health Care, December 1, 2005; 17(6): 511 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Intrator, Z. Feng, V. Mor, D. Gifford, M. Bourbonniere, and J. Zinn The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes Gerontologist, August 1, 2005; 45(4): 486 - 495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Kane, P. Homyak, B. Bershadsky, T. Lum, S. Flood, and H. Zhang The Quality of Care Under a Managed-Care Program for Dual Eligibles Gerontologist, August 1, 2005; 45(4): 496 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Arling, R. L. Kane, T. Lewis, and C. Mueller Future Development of Nursing Home Quality Indicators Gerontologist, April 1, 2005; 45(2): 147 - 156. [Abstract] [Full Text] [PDF]
|
|
| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
