Cost analysis of a home-based nurse care coordination program

Karen Marek, Frank Stetzer, Scott J. Adams, Linda Denison Bub, Andrea Schlidt, Karen Jiggins Colorafi

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Objectives To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost.

Design Randomized, controlled, three-arm longitudinal study.

Setting Participant homes in a large Midwestern urban area.

Participants Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414). Intervention A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group.

Measurements To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files.

Results Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P =.11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P =.06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group.

Conclusion Nurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention.

Original languageEnglish (US)
Pages (from-to)2369-2376
Number of pages8
JournalJournal of the American Geriatrics Society
Volume62
Issue number12
DOIs
StatePublished - Dec 1 2014

Keywords

  • care coordination
  • cost effectiveness
  • self-management

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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    Marek, K., Stetzer, F., Adams, S. J., Bub, L. D., Schlidt, A., & Colorafi, K. J. (2014). Cost analysis of a home-based nurse care coordination program. Journal of the American Geriatrics Society, 62(12), 2369-2376. https://doi.org/10.1111/jgs.13162