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Exploring Indicators of Use of Costly Health Services in Community-Dwelling Adults With Multiple Chronic Conditions

Holland, Diane E. PhD, RN; Vanderboom, Catherine E. PhD, RN; Lohse, Christine M. MS; Mandrekar, Jay PhD; Targonski, Paul V. PhD, MD; Madigan, Elizabeth PhD, RN, FAAN; Powell, Suzanne K. RN, MBA, CCM, CPHQ

doi: 10.1097/NCM.0000000000000060
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Although experts recognize that including patient functional and social variables would improve models predicting risk of using costly health services, these self-reported variables are not widely used.

Purpose of Study: Explore differences in predisposing characteristics, enabling resources, patient-perceived need for care and professionally evaluated need for care variables between patients receiving primary care within a Health Care Home who did and did not use hospital, emergency department, or skilled nursing facility services in a 3-month period of time.

Primary Practice Setting(s): Primary care.

Methodology and Sample: Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted on data from a study that included 57 community-dwelling older adults receiving primary care in a Health Care Home. Because of the exploratory nature of the study, group differences in the use of costly care services were compared at the 0.10 level of statistical significance.

Results: Seventeen patients (29.8%) experienced costly care services. The greatest number of differences in variables between groups was in the category of patient-perceived need for care (functional impairments, dependencies, difficulties).

Implications For Case Management Practice: Targeting case management services using evidence-based decision support tools such as prediction models enhances the opportunity to maximize outcomes and minimize waste of resources. Patient-perceived and clinician-evaluated need for care may need to be combined to fully describe the contextual needs that drive the use of health services. Difficulty with Activities with Daily Living and Instrumental Activities of Daily Living should be considered in future studies as candidate predictor variables for need for case management services in primary care settings.

Diane E. Holland, PhD, RN, is a Clinical Nurse Researcher in the Department of Nursing and an Associate Professor in Nursing, Mayo Clinic College of Medicine in Rochester, MN. Dr. Holland leads a program of research in the successful transition of care from the hospital to the community. Her research team has produced empirically based discharge planning decision support tools for adults and pediatric patients. Dr. Holland has published and presented widely.

Catherine E. Vanderboom, PhD, RN, is a Clinical Nurse Researcher in the Department of Nursing and an Assistant Professor in Nursing, Mayo Clinic College of Medicine in Rochester, MN. Dr. Vanderboom's research has focused upon care for community-dwelling older adults with chronic conditions, and on nurse care coordination, primary care nursing, and technology enhanced nurse interventions.

Christine M. Lohse, MS, is a statistician in the Department of Biomedical Statistics and Informatics at Mayo Clinic in Rochester, MN. Ms. Lohse provides statistical analysis for research conducted within the Department of Nursing at Mayo Clinic.

Jay Mandrekar, PhD, is a statistician in the Department of Biomedical Statistics and Informatics and Professor of Biostatistics in the College of Medicine at Mayo Clinic in Rochester, MN. Dr. Mandrekar provides statistical oversight and education for studies conducted within the Department of Nursing at Mayo Clinic.

Paul V. Targonski, PhD, MD, is a consultant in Internal Medicine and Associate Professor of Medicine in the College of Medicine at Mayo Clinic in Rochester, MN. Dr. Targonski is also the director of the Practice Based Research Network, which provides resources for research conducted within the Mayo Clinic Health System.

Elizabeth Madigan, PhD, RN, FAAN, is Associate Dean for Academic Affairs and Independence Foundation Professor of Nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University. Dr. Madigan's research has focused upon Home Health Care Issues, Health Services Use, and International Health Care Issues.

Suzanne K. Powell, RN, MBA, CCM, CPHQ, is Editor-in-Chief of Professional Case Management.

Address correspondence to Diane E. Holland, PhD, RN, Mayo Clinic, Nursing Research Division, 200 First Street S.W., Rochester, MN 55905 (Holland.diane@mayo.edu).

The authors report no conflicts of interest.

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins.