Assessing cost effects of nursing-home-based geriatric nurse practitioners

Health Care Financing Review, Spring, 1990 by Joan L. Buchanan, Robert M. Bell, Sharon B. Arnold, Christina Witsberger, Robert L. Kane, Judith Garrard

For the continuing-resident group, we found no evidence of either a GNP effect or increased use in the post-period for the control group. Residents from homes where the GNP role was not implemented had marginally higher post-period expenditures in the basic model.

Components of medical service use

An important early hypothesis was that use of GNPs would reduce hospitalization costs. We also anticipated that the use of restorative-type services would increase as GNPs made greater efforts to return patients to higher levels of independent functioning. In part, these conflicting hypotheses led to the development of the imputed cost methodology, because dollars form a convenient metric for combining different services into a single measure. Having observed that costs for patients in GNP homes fell relative to costs in the control group, we would now like to understand what services contributed to the initially higher pre-period costs in GNP homes and how the use of these services changed through time for the two groups. Because patients were followed for different lengths of time, we express these figures as rates of use per study day.

For every type of service, new admissions to GNP homes had higher pre-period use rates than new admissions to control homes. These differences were statistically significant for 6 of the 14 reported measures--physician visits with examination, dental visits, laboratory and radiology orders, occupational therapy, and regular prescription drugs at both admission and discharge (Table 6). In the post-period, the use of these six services remained higher in the GNP group. In addition, the difference in use of physical therapy and emergency room visits increased to statistically significant levels. The drop in costs resulted exclusively from the reduction in hospitalization measures for GNP patients. In the post-period, the admission rate for patients in GNP homes was significantly below the rate in control homes, and the number of inpatient days for both elective and emergency stays fell to levels below those in control homes. The reduction from pre- to post-period was statistically significant for emergency hospital days. Within the control group, hospitalization increased between the two periods.

In the pre-period, relatively fewer real differences are observed between the GNP and control groups within the continuing-resident population than between the GNP and control groups in the new-admission population. In the post-period, patients from GNP homes used significantly more therapy than patients in control homes. As with new admissions, all three hospitalization measures for continuing residents in GNP homes fell considerably from the pre-period to levels below those of the control group. However, for the continuing-resident group, this post-period difference was not statistically significant. In the continuing-resident control group, hospitalization rates increased slightly between the periods, the same pattern seen in the new-admission control cohort.