Effect of a Community-based Nursing Intervention on Mortality in Chronically Ill Older Adults

NCT01071967 | Unknown

• 1 other identifier: 95-C-91360/3-01
• Study Type: interventional
• Target: 2,000
• Locations: 1 country
• Sites: 1

Brief Summary

Care coordination, disease management, geriatric care management, and preventive programs for chronically ill older adults vary in design and their impact on long-term health outcomes is not well established. This study investigates whether a community-based nursing intervention improves longevity and impact on cardiovascular risk factors in this population. The results reflect the impact of one of the study sites (Health Quality Partners) selected by the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Coordinated Care Demonstration, a national demonstration designed to identify promising models of care coordination for chronically ill older adults. The study began in April 2002.

Conditions

Heart Failure; Coronary Disease; Diabetes Mellitus; Asthma; Hypertension; Hypercholesterolemia

Keywords

Community Health Nursing; Nursing Care Management; Aged; Aged, 80 and over; Health Services for the Aged; Geriatric Nursing; Geriatric Assessment; Longevity; Mortality

Outcome Measures

Primary Outcomes (1)

• All-cause mortality

  within 5 years of enrollment

Secondary Outcomes (5)

• Blood pressure control

  within 5 years of enrollment

• Total cholesterol control

  within 5 years of enrollment

• Low density cholesterol control

  within 5 years of enrollment

• Triglycerides control

  within 5 years of enrollment

• Weight control

  within 5 years of enrollment

Study Arms (2)

Community-based nurse care management

EXPERIMENTAL

Participants randomized to receive the intervention worked with a nurse care manager who provided them with a comprehensive set of geriatric and chronic disease preventive services.

Other: Community-based nurse care management

Usual care

NO INTERVENTION

Participants randomized to the control group received usual care without the involvement of a nurse care manager.

Interventions

Community-based nurse care management OTHER

The community-based nurse care management program developed by Health Quality Partners uses nurses working in the community to provide the following integrated set of services to older adults with chronic illness over the long term in order to prevent avoidable complications of their diseases and aging; geriatric assessment, care coordination, health education, self-management coaching, weight management, physical activity, gait and balance training, medication adherence, care transition support, ongoing monitoring and symptom detection, collaborative problem solving with patients, families and health care providers.

Also known as: Health Quality Partners, Medicare Coordinated Care Demonstration, Care Coordination, Disease Management

Community-based nurse care management

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Aged 65 years and older
• Medicare Part A and B traditional, fee for service insurance coverage
• One or more of the following chronic conditions:
• Heart failure
• Coronary Disease
• Diabetes mellitus
• Asthma
• Hypertension
• Hypercholesterolemia
• A Geriatric Risk Stratification Level of 2 or more based on a pre-enrollment screening tool
• Geriatric Risk Stratification Level changed in Sep 2006 to a Level of 3 or more
• Willingness of the participant's primary care provider to collaborate

You may not qualify if:

• Amyotrophic lateral sclerosis
• Alzheimer's disease
• Dementia
• Diagnosis or history of cancer (other than skin) in the past 5 years
• End-stage renal disease
• Life expectancy on enrollment less than 6 months
• HIV or AIDS
• Huntington's disease
• Organ transplant candidate
• Psychosis or schizophrenia
• Resident of or imminent plan for long-term nursing home placement
• Seasonal relocation outside of the area for more than 4 weeks per year
• Anyone receiving service from Health Quality Partners in the past

Sponsors & Collaborators

• Health Quality Partners: lead
• Centers for Medicare and Medicaid Services: collaborator

Study Sites (1)

Health Quality Partners

Doylestown, Pennsylvania, 18902, United States

Location

Related Publications (4)

• Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009 Feb 11;301(6):603-18. doi: 10.1001/jama.2009.126.

  PMID: 19211468 BACKGROUND

• Brown R, Peikes D, Chen A, Schore J. 15-site randomized trial of coordinated care in Medicare FFS. Health Care Financ Rev. 2008 Fall;30(1):5-25.

  PMID: 19040171 BACKGROUND

• Bott DM, Kapp MC, Johnson LB, Magno LM. Disease management for chronically ill beneficiaries in traditional Medicare. Health Aff (Millwood). 2009 Jan-Feb;28(1):86-98. doi: 10.1377/hlthaff.28.1.86.

  PMID: 19124858 BACKGROUND

• Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N. Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med. 2012;9(7):e1001265. doi: 10.1371/journal.pmed.1001265. Epub 2012 Jul 17.

  PMID: 22815653 DERIVED

Related Links

• Health Quality Partners
• Related ClinicalTrials.gov study

MeSH Terms

Conditions

Heart Failure; Coronary Disease; Diabetes Mellitus; Asthma; Hypertension; Hypercholesterolemia

Interventions

Disease Management

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Myocardial Ischemia; Vascular Diseases; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Hyperlipidemias; Dyslipidemias; Lipid Metabolism Disorders

Intervention Hierarchy (Ancestors)

Patient Care Management; Health Services Administration

Study Officials

• Kenneth D Coburn, MD, MPH

  Health Quality Partners

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 16, 2009
• First Posted: February 19, 2010
• Study Start: April 1, 2002
• Primary Completion: December 1, 2014
• Study Completion: December 1, 2016
• Last Updated: September 10, 2013

Record last verified: 2013-09

Locations

US (1)