Abstract: Geriatric Nurse Practitioners in Long-Term Care: Demonstration of Effectiveness in Managed Care

Jeffrey B. Burl, MD, Alice Bonner, RN, CS, Maithili Rao, MBA, and Anwer M. Khan, MS. "Geriatric Nurse Practitioners in Long-Term Care: Demonstration of Effectiveness in Managed Care." Journal of the American Geriatrics Society 46 (April 1998) 4: 506-510.

Objectives:
* To determine how employing a geriatric nurse practitioner (GNP) to help physicians care for nursing home residents influences the cost and quality of care for residents enrolled in Medicare HMOs.

Methods:
* A one-year retrospective analysis of data pertaining to cost and patient health was conducted for 1077 HMO enrollees residing in 45 long-term care facilities in central Massachusetts. The results for residents cared for by GNP/MD teams were compared to those for residents cared for by physicians alone.
* In facilities employing a GNP/MD team, the GNP was responsible for the initial history and physical of incoming nursing-home residents. She developed a comprehensive plan of care for the patient, addressing medical, functional, and psychosocial issues, and later approved services, such as physical, occupational, speech therapies, and mental health services. The GNP and MD alternated regulatory visits, so that one cycle was a team visit, and the next was done either by the team or by the GNP alone.
* Data on overall cost, revenues, emergency department transfers, hospital, and subacute days was collected.

Results:
* Of 1077 residents studied, 663 were cared for by physicians alone and 414 were cared for by GNP/MD teams.
* GNPs were able to manage medically complex residents on site at the nursing home, thus lowering the cost of care while circumventing the risks associated with transferring frail elderly patients to the emergency department: "On average, residents covered by the GNP/MD teams utilized fewer services, and total expenditure was significantly less for these residents (P = .011). Significantly lower costs were found for emergency department, hospital, and skilled nursing for the GNP/MD Team-managed residents compared with the MD Only-managed pool."
* There was a gain of $72 per resident per month for GNP/MD-covered patients, compared with a loss of $197 per resident per month for patients covered by physicians alone.

Conclusions:
* "The use of GNPs in collaboration with physicians reduced emergency department and acute care utilization costs as well as overall costs" for nursing home residents enrolled in the central Massachusetts HMO.
* "The data here appear to be sufficient to encourage the use of GNP/MD teams in long-term care as a model of high quality health-care delivery" in the nursing home setting.

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