Utilization of the Health Care System of Community Case Management Patients

PURPOSE OF STUDY: The has reduced payments to hospitals that have excessive readmissions. This mandate has made it imperative for hospitals to implement a plan to manage readmissions and transitions of care for patients they serve. The purpose of this study was to ascertain whether an advanced practice, nurse-led, community-based model is effective in reducing acute health care utilization. PRIMARY PRACTICE SETTING: The community case management (CCM) program was created more than 20 years ago to assess and manage care of patients demanding frequent emergency department (ED) visits and frequent hospitalizations, by providing in-home visits and care coordination by an advanced practice nurse or masters-prepared nurse. METHODOLOGY AND SAMPLE: The charts of 307 patients who were referred to CCM were reviewed to assess their utilization of the health care system after referral. There were 2 groups of patients: those who accepted CCM services (N = 151) and those who refused CCM services (N = 156) upon referral. RESULTS: It was found that if patients accepted CCM services, they had 55% fewer visits to the ED and 61% fewer hospital admissions than patients who refused CCM services. Utilization of urgent care was decreased by 47% in the patients who accepted CCM services, but this decline was not statistically significant. IMPLICATION FOR CASE MANAGEMENT PRACTICE: The results of this study indicate that CCM is effective in decreasing hospital admissions and ED visits for the patients using CCM services. Implementing a CCM program could be an effective method for decreasing utilization of the hospital and ED by adult patients with at least 1 chronic disease.