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ADVANCING GERIATRIC NURSING PRACTICE: Geriatric Nurse Practitioners in Long‐Term Care: Demonstration of Effectiveness in Managed Care
Author(s) -
Burl Jeffrey B.,
Bonner Alice,
Rao Maithili,
Khan Anwer M.
Publication year - 1998
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1998.tb02475.x
Subject(s) - medicine , nursing , geriatric care , gerontological nursing , long term care , geriatrics , term (time) , family medicine , psychiatry , physics , quantum mechanics
OBJECTIVE: This study was undertaken to review the impact of utilizing geriatric nurse practitioner/physician (GNP/MD) teams on cost and utilization for a cohort of Medicare HMO enrollees residing in long‐term care facilities. The results would be used by the organization for further development of the GNP Program. DESIGN: A 1‐year retrospective data analysis on revenues and cost for 1077 HMO enrollees residing in 45 long termcare facilities. SETTING: Proprietary and not‐for‐profit, licensed long term care facilities in the HMO's service area of central Massachusetts. Facilities in the study had both skilled (Medicare‐certified) and custodial beds. MEASUREMENTS: Data were collected retrospectively on overall cost, revenues, emergency department (ED) transfers, hospital, and subacute days. RESULTS: Of 1077 residents, 414 were cared for by GNP/MD teams compared with 663 by physicians alone. Acute care and ED costs were significantly lower for the GNP/MD‐covered patients. There was a gain of $72 per resident per month (PRPM) with the GNP/MD‐covered patients compared with a loss of $197 PRPM for physicians alone. There were no significant differences in ancillary services or prescriptions. CONCLUSION: The use of GNPs in collaboration with physicians reduced ED and acute care utilization costs as well as overall costs for a cohort of HMO enrollees in long‐term care. This encouraged the HMO to support the concept that all long‐term care HMO residents should be covered by GNP/MD teams.