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Outcomes in a Nursing Home Transition Case-Management Program Targeting New Admissions

Correspondence: Address correspondence to Robert Newcomer, PhD, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118. E-mail: robert.newcomer{at}ucsf.edu

Purpose: The Providing Assistance to Caregivers in Transition (PACT) program offers nursing home discharge planning and case management for individuals in the transitional period following a return to the community. The PACT program targeted individuals newly admitted to nursing homes and worked with a family caregiver to develop and implement a nursing home discharge plan. Design and Method: Reported are the results of a randomized control design evaluating the program's effectiveness. Those individuals randomly assigned to the intervention group (n = 33) received PACT case management in addition to their usual medical and nursing home care. The individuals in the control group (n = 29) continued their usual care. Result: There were no statistical differences in the discharge rate (84% treatment vs 76% controls) or in the median length of stay (42 days vs 55 days) between the two groups of individuals. Implications: Replications or extensions of a PACT-type intervention might consider a broader mix of nursing homes, working directly with the nursing home's admission Minimum Data Set coordinator in patient selection, or working with Medicare or Medicaid HMO plans.

Key Words: Nursing home • Case management • Postacute care • Geriatrics

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