Effect of a clinical case manager/clinical nurse specialist on patients hospitalized with congestive heart failure.

The purpose of this study was to evaluate the effect of case management by a Clinical Case Manager/Clinical Nurse Specialist (CCM/CNS) on hospitalized length of stay and hospital charge throughout a 12-month period for patients with congestive heart failure. A total of 491 patients were discharged during 1997 with a diagnosis-related group code of 127. Of this number, 88 were case managed by a CCM/CNS. The remaining 403 received the usual management of their care. The group who were case managed by the CCM/CNS demonstrated significantly shorter length of stay (t = 5.40, P < 0.00) and lower hospital charges (t = 4.26, P < 0.00) than the patients with congestive heart failure who were not case managed. Secondary analysis indicated a significant interaction between case management and involvement of a cardiologist in the care of the patient. Patients whose care involved a cardiologist without case management by a CCM/CNS demonstrated significantly greater (alpha = 0.01) length of stay and hospital charges than patients who were case managed by a CCM/CNS or patients whose care did not involve a cardiologist.