Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people.

Aim: The purpose of this study was to test the effectiveness of a collaborative primary care nurse case management intervention emphasising collaboration between physicians, nurses and patients, risk identification, comprehensive assessment, collaborative planning, health monitoring, patient education and transitional care on healthcare utilisation and cost for community dwelling chronically ill older persons.

Background: Primary care teams comprised of nurses and primary care physicians have been suggested as a model for providing quality care to the chronically ill, but this type of intervention has not been systematically evaluated.

Design: A non-randomised, 36 month comparison of two geographically distinct primary care populations was conducted.