Award Date

5-1-2021

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Reimund Serafica

Second Committee Member

Mary Bondmass

Third Committee Member

Lung-Chang Chien

Number of Pages

48

Abstract

Background: Individuals living with multiple chronic conditions (MCC) account for 26% of the population; however, they consume 84% of healthcare resources, are three times more likely to have depression than healthy individuals, and have increase emergency room (ER) visits and healthcare resource use. This population requires coordinated health care to reduce unnecessary spending and the misappropriation of healthcare resources. The purpose of this project was to evaluate the efficacy of care coordination (CC) and the support system it provides in lowering depression symptoms and ER visit frequency as a viable measure to reduce overall healthcare costs.

Methods: The healthcare providers, care coordinators, and office staff were informed of the project and provided weekly briefings to acknowledge milestones and answer questions. The healthcare provider identified CC candidates and referred them to the care coordinator. The participant completed a PHQ-9 tool, and the results were recorded in the patient's medical record and given to the healthcare provider and the student investigator. Participants began using CC services, and care coordinators developed care plans approved by the PCP. CC services supported care transition, education services, and healthcare resource coordination between PCPs and specialists; promoted self-care and treatment adherence; and streamlined access to the PCP through telephone and face-to-face communication. The coordinator contacted the patient every two weeks if no contact had occurred within that time. Participants were encouraged to call their care coordinator with any health changes, medication or treatment questions, or health-related concerns. The care coordinator approached the PCP with any patient concerns or problems identified, which were promptly addressed. The number of contacts between care coordinators and each patient ranged from 7 to 44 during this study. Patients completed a follow-up PHQ-9 three months after initiating CC services. These were recorded in the medical record and given to the PCP and student investigator. The billing manager populated reports from the CMS claims data on the ER visit frequency for the three months before and during enrollment in CC services.

Results: The paired t-test showed a statistically significant reduction in PHQ-9 scores (p= 0.008) and ER visit frequency (p= 0.005) with the intervention.

Conclusion: The project concluded that CC services and their support statistically reduced depression symptoms, evidenced by PHQ-9 scores and ER visit frequency. These positive, quantifiable results may provide evidence-based outcomes to support the benefits of incorporating CC into overall patient care and influence private health insurance companies to reimburse CC services.

Keywords

Care Coordination; Depression; ER visits; Multiple chronic conditions

Disciplines

Health and Medical Administration | Mental and Social Health | Nursing

File Format

pdf

File Size

1108 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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