Elder case management by registered nurses.

PURPOSE/OBJECTIVES: Before integrating advanced practice registered nurse (APRN) case management, we compared managed Medicare clients' hospital admissions for 12 months prior to and 12 months after registered nurse (RN) or social worker case management.

PRIMARY PRACTICE SETTING(S): Our clients are cared for by a multispecialty physician group and five local hospitals.

FINDINGS/CONCLUSIONS: The 12-month admissions dropped from 351 to 101. There was a 75.5% reduction for Level 1 clients, a 72% reduction for Level 2 clients, and a 25% reduction for Level 3 clients.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

(1) RNs, APRNs, and social workers are educated to holistically manage care for elders with chronic disease who require physiological, psychosocial, spiritual, and environmental interventions, not just disease treatment. (2) The complex interaction between aging and chronic disease in elders necessitates RN, social worker, and/or APRN case management. (3) Although RNs, social workers, and APRNs can work independently, dyads may be more effective.