IMPACT OF INTEGRATED COMMUNITY NURSING SERVICES ON HOSPITAL UTILIZATION AND COSTS IN A MEDICARE RISK PLAN

This study measures the impact of integrated community nursing service s on hospital use and costs for elderly people in a health maintenance organization (HMO). We tracked 4,943 HMO patients over three consecut ive five-month periods (one preintervention and two postintervention). We compared 326 patients who entered a program of integrated services during period 2 with 301 patients who entered during period 3 and 4,3 16 nonprogram patients in respect to their utilization and costs durin g periods 2 and 3. Regression results reveal that patients receiving i ntegrated services had significantly higher utilization and costs duri ng the period of enrollment and significantly lower utilization and co sts during the period following enrollment, compared to nonprogram pat ients. These results were replicated when considering only patients wi th observed episodes of care in these periods, when controlling for ho spital use and costs in the prior period and when controlling for the risk of selection into the program. The findings suggest that integrat ing services at the community level may achieve substantial cost savin gs.