Proactive care saves lives of seniors, s...( PORTLAND Ore. Can a patient-centere...),Health

PORTLAND, Ore. Can a patient-centered, care management program utilizing nurse care managers and interdisciplinary teams, supported by electronic tracking and care coordination systems reduce the rate of deaths and hospitalizations among chronically ill older adults? The answer based on a three-year study involving more than 3,400 chronically ill seniors led by Oregon Health & Science University researcher David A. Dorr, M.D. appears to be "yes."

The study described in the December 2008 Journal of the American Geriatrics Society has broad implications for how the care of the more than 130 million Americans with chronic illnesses, two thirds of whom are 65 or older, is managed.

"This study underscores the enormous societal costs of a health care infrastructure that does not adequately support the interdisciplinary services and care coordination needed to prevent adverse outcomes for older adults with multiple chronic illnesses," said Dorr, the study's lead investigator and an assistant professor of medical informatics and clinical epidemiology at OHSU.

"Patients coping with two chronic health conditions are eight times as likely to die within a year as peers with one such illness, " said Dorr. "Someone with three or more chronic illnesses has 40 times higher odds of being hospitalized than a person with a single chronic illness and 91 times higher odds than someone with no such illness. We also know that chronic conditions account for 83 percent of all healthcare spending and that the majority of cost increases in Medicare spending are due to patients with five or more chronic illnesses."

The study conducted between January 1, 2002 and June 30, 2005 at 13 primary care clinics at Intermountain Healthcare, a large not-for-profit integrated health care system in Utah found that deaths among the 1,144 patients in the "intervention" group receiving optimum care, called Care Management Plus (CMP), were significantly lower in the first
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