Gl. Klein et al., NUTRITION AND HEALTH FOR OLDER PERSONS IN RURAL AMERICA - A MANAGED CARE MODEL, Journal of the American Dietetic Association, 97(8), 1997, pp. 885-888
Health care services and resources for older persons living in rural a
reas may be highly variable, and integrated service-delivery models ar
e often lacking. This article presents a managed-care model of nutriti
on risk screening and intervention for older persons in rural areas. N
utrition risk screening was implemented by the Geisinger Health Care S
ystem, Danville, Pa, to target all eligible enrollees in a regional Me
dicare risk program. A single remote clinic site participating in the
managed health care system was chosen for further study of a linked sc
reening and case-management effort for undernourished persons. Screeni
ng and intervention at the clinic site selected for this study were gu
ided by centralized expertise and resources. Individualized evaluation
and intervention plans were developed with the aid of a dietitian and
implemented by the clinic case manager. Of the 417 subjects who compl
eted screening at the remote site, 68 met the risk criteria for undern
utrition and were selected for case management. Many of the targeted p
ersons received interventions that included evaluations by a physician
or physician extender (eg, physician assistant, nurse practitioner) a
t the clinic and consultations with nutrition, mental health, or socia
l services professionals. Twenty-six of the subjects who took part in
the intervention completed a follow-up screening 6 months later. Ten o
f those persons no longer exhibited risk criteria. This demonstrates t
he feasibility of a linked screening and case management program for n
utrition risk in the managed-care setting.