Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions
Objectives To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage t...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2013-06, Vol.61 (6), p.857-867 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
| container_volume | 61 |
| creator | Reuben, David B. Ganz, David A. Roth, Carol P. McCreath, Heather E. Ramirez, Karina D. Wenger, Neil S. |
| description | Objectives
To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions.
Design
Case study.
Setting
Two community‐based primary care practices.
Participants
Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression.
Intervention
The ACOVE‐2 model augmented by NP comanagement of conditions.
Measurements
Quality of care according to medical record review using ACOVE‐3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices.
Results
Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P |
| doi_str_mv | 10.1111/jgs.12268 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1419337269</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1419337269</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4898-7b339b7c617ebc76c4078674028adec148885d37222225767d268533d42d60ec3</originalsourceid><addsrcrecordid>eNqF0U1rFEEQBuBGFLNGD_4BGRBBD5P0d_UcdYmrEqNoJOKl6e2pib2Zj9g9g-bf25PdRBDEuvTlqSqqX0IeM3rAch1uztMB41ybO2TBlOClkkzdJQtKKS-NZnKPPEhpQynj1Jj7ZI8LAA5cLMj7o6ZBPxZDU5xMMWHxMTo_hjEMPcZiOXSud-fYYZ9JX4zfsVi6iDNfYQxujMFn1dfXHekhude4NuGj3btPvrw-Ol2-KY8_rN4uXx6XXprKlLAWolqD1wxw7UF7ScFokJQbV6Nn0hijagF8LgUa6nybEqKWvNYUvdgnz7dzL-PwY8I02i4kj23rehymZJlklcj9uvo_FboCBkBZpk__opthin0-ZFagNDdCZvViq3wcUorY2MsYOhevLKN2jsPmOOx1HNk-2U2c1h3Wt_Lm_zN4tgMuedc20fU-pD8OVM5Qze5w636GFq_-vdG-W32-WV1uO0Ia8ddth4sXVoMAZc9OVvbV10-n6uybsEr8Bv63rFQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1367562834</pqid></control><display><type>article</type><title>Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Reuben, David B. ; Ganz, David A. ; Roth, Carol P. ; McCreath, Heather E. ; Ramirez, Karina D. ; Wenger, Neil S.</creator><creatorcontrib>Reuben, David B. ; Ganz, David A. ; Roth, Carol P. ; McCreath, Heather E. ; Ramirez, Karina D. ; Wenger, Neil S.</creatorcontrib><description>Objectives
To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions.
Design
Case study.
Setting
Two community‐based primary care practices.
Participants
Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression.
Intervention
The ACOVE‐2 model augmented by NP comanagement of conditions.
Measurements
Quality of care according to medical record review using ACOVE‐3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices.
Results
Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P < .001), as did NP estimate of medical management style (P = .02).
Conclusion
NP comanagement is associated with better quality of care for geriatric conditions in community‐based primary care than usual care using the ACOVE‐2 model.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.12268</identifier><identifier>PMID: 23772723</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Hoboken, NJ: Blackwell Publishing Ltd</publisher><subject>ACOVE ; Aged, 80 and over ; Biological and medical sciences ; Community health care ; Disease Management ; Female ; General aspects ; geriatric conditions ; Geriatrics ; Health participants ; Humans ; Interprofessional Relations ; Male ; Medical sciences ; Miscellaneous ; Nurse practitioners ; Nurse Practitioners - organization & administration ; Older people ; Physicians ; Physicians, Primary Care ; practice redesign ; Primary Care Nursing - methods ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; quality improvement ; Quality of Health Care - standards ; Retrospective Studies</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2013-06, Vol.61 (6), p.857-867</ispartof><rights>2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society</rights><rights>2014 INIST-CNRS</rights><rights>2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.</rights><rights>2013 American Geriatrics Society and Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4898-7b339b7c617ebc76c4078674028adec148885d37222225767d268533d42d60ec3</citedby><cites>FETCH-LOGICAL-c4898-7b339b7c617ebc76c4078674028adec148885d37222225767d268533d42d60ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.12268$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.12268$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27500053$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23772723$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reuben, David B.</creatorcontrib><creatorcontrib>Ganz, David A.</creatorcontrib><creatorcontrib>Roth, Carol P.</creatorcontrib><creatorcontrib>McCreath, Heather E.</creatorcontrib><creatorcontrib>Ramirez, Karina D.</creatorcontrib><creatorcontrib>Wenger, Neil S.</creatorcontrib><title>Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives
To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions.
Design
Case study.
Setting
Two community‐based primary care practices.
Participants
Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression.
Intervention
The ACOVE‐2 model augmented by NP comanagement of conditions.
Measurements
Quality of care according to medical record review using ACOVE‐3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices.
Results
Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P < .001), as did NP estimate of medical management style (P = .02).
Conclusion
NP comanagement is associated with better quality of care for geriatric conditions in community‐based primary care than usual care using the ACOVE‐2 model.</description><subject>ACOVE</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Community health care</subject><subject>Disease Management</subject><subject>Female</subject><subject>General aspects</subject><subject>geriatric conditions</subject><subject>Geriatrics</subject><subject>Health participants</subject><subject>Humans</subject><subject>Interprofessional Relations</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Nurse practitioners</subject><subject>Nurse Practitioners - organization & administration</subject><subject>Older people</subject><subject>Physicians</subject><subject>Physicians, Primary Care</subject><subject>practice redesign</subject><subject>Primary Care Nursing - methods</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>quality improvement</subject><subject>Quality of Health Care - standards</subject><subject>Retrospective Studies</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0U1rFEEQBuBGFLNGD_4BGRBBD5P0d_UcdYmrEqNoJOKl6e2pib2Zj9g9g-bf25PdRBDEuvTlqSqqX0IeM3rAch1uztMB41ybO2TBlOClkkzdJQtKKS-NZnKPPEhpQynj1Jj7ZI8LAA5cLMj7o6ZBPxZDU5xMMWHxMTo_hjEMPcZiOXSud-fYYZ9JX4zfsVi6iDNfYQxujMFn1dfXHekhude4NuGj3btPvrw-Ol2-KY8_rN4uXx6XXprKlLAWolqD1wxw7UF7ScFokJQbV6Nn0hijagF8LgUa6nybEqKWvNYUvdgnz7dzL-PwY8I02i4kj23rehymZJlklcj9uvo_FboCBkBZpk__opthin0-ZFagNDdCZvViq3wcUorY2MsYOhevLKN2jsPmOOx1HNk-2U2c1h3Wt_Lm_zN4tgMuedc20fU-pD8OVM5Qze5w636GFq_-vdG-W32-WV1uO0Ia8ddth4sXVoMAZc9OVvbV10-n6uybsEr8Bv63rFQ</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Reuben, David B.</creator><creator>Ganz, David A.</creator><creator>Roth, Carol P.</creator><creator>McCreath, Heather E.</creator><creator>Ramirez, Karina D.</creator><creator>Wenger, Neil S.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>201306</creationdate><title>Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions</title><author>Reuben, David B. ; Ganz, David A. ; Roth, Carol P. ; McCreath, Heather E. ; Ramirez, Karina D. ; Wenger, Neil S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4898-7b339b7c617ebc76c4078674028adec148885d37222225767d268533d42d60ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>ACOVE</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Community health care</topic><topic>Disease Management</topic><topic>Female</topic><topic>General aspects</topic><topic>geriatric conditions</topic><topic>Geriatrics</topic><topic>Health participants</topic><topic>Humans</topic><topic>Interprofessional Relations</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Nurse practitioners</topic><topic>Nurse Practitioners - organization & administration</topic><topic>Older people</topic><topic>Physicians</topic><topic>Physicians, Primary Care</topic><topic>practice redesign</topic><topic>Primary Care Nursing - methods</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>quality improvement</topic><topic>Quality of Health Care - standards</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reuben, David B.</creatorcontrib><creatorcontrib>Ganz, David A.</creatorcontrib><creatorcontrib>Roth, Carol P.</creatorcontrib><creatorcontrib>McCreath, Heather E.</creatorcontrib><creatorcontrib>Ramirez, Karina D.</creatorcontrib><creatorcontrib>Wenger, Neil S.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reuben, David B.</au><au>Ganz, David A.</au><au>Roth, Carol P.</au><au>McCreath, Heather E.</au><au>Ramirez, Karina D.</au><au>Wenger, Neil S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2013-06</date><risdate>2013</risdate><volume>61</volume><issue>6</issue><spage>857</spage><epage>867</epage><pages>857-867</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives
To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions.
Design
Case study.
Setting
Two community‐based primary care practices.
Participants
Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression.
Intervention
The ACOVE‐2 model augmented by NP comanagement of conditions.
Measurements
Quality of care according to medical record review using ACOVE‐3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices.
Results
Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P < .001), as did NP estimate of medical management style (P = .02).
Conclusion
NP comanagement is associated with better quality of care for geriatric conditions in community‐based primary care than usual care using the ACOVE‐2 model.</abstract><cop>Hoboken, NJ</cop><pub>Blackwell Publishing Ltd</pub><pmid>23772723</pmid><doi>10.1111/jgs.12268</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-8614 |
| ispartof | Journal of the American Geriatrics Society (JAGS), 2013-06, Vol.61 (6), p.857-867 |
| issn | 0002-8614 1532-5415 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1419337269 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | ACOVE Aged, 80 and over Biological and medical sciences Community health care Disease Management Female General aspects geriatric conditions Geriatrics Health participants Humans Interprofessional Relations Male Medical sciences Miscellaneous Nurse practitioners Nurse Practitioners - organization & administration Older people Physicians Physicians, Primary Care practice redesign Primary Care Nursing - methods Public health. Hygiene Public health. Hygiene-occupational medicine quality improvement Quality of Health Care - standards Retrospective Studies |
| title | Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions |
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