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The purpose of this study was to identify characteristics of chronically ill community-dwelling older adults that differentiate the intensity of care provided by nurse care coordinators. We performed data mining on electronic health records, nurses' activity logs, and health status measures from 784 care episodes provided to 196 older adults. An inductively created decision tree identified nine groups from a combination of the six participant characteristics including medication regimen complexity, cognition, physical and mental health, hospital admission, and physical functioning. Overall there was a 5-hr difference in the intensity (or contact hours) per quarter of nurse care coordinators between individuals in the highest versus lowest intensity groups. The highest intensity group presented higher medication complexity and lower mental/physical health status. With caseloads of 30 to 35 participants, nurse care coordinators were able to provide care based on participant needs that were not influenced by regulatory payment requirements.

Profiling Patient Characteristics Associated With the Intensity of Nurse Care Coordination