A Randomized Trial of RN Coordinated Prevention Services

Coordination of care will become increasingly important to the delivery of military health care as the armed services move toward a model of managed care which emphasizes health promotion/disease prevention. Research is beginning to indicate that patient care outcomes are related to how effectively care is coordinated. There are recognized mechanisms for the coordination of care; however, it remains unknown as to how and when these mechanisms should be used to achieve cost-effective outcomes. Nurses' focus on care coordination and health promotion/disease prevention has been recognized as instrumental to the delivery of cost-effective, primary care services. Care coordination, however, is the least frequently performed task by nurses in primary care settings and there currently exists little agreement on how the role of care coordinator relative to health promotion/disease prevention should be enacted. Our long term goals are to promote military readiness, minimize the burden of illness, and decrease the demand for additional care by using nurse coordinated, guideline-based health promotion/disease prevention practices to promote effective movement through the military medical system. The specific aims of this study are to: 1) determine if a Primary Care Nurse Liaison (PCNL) model of health promotion/disease prevention care coordination increases quality and cost-effectiveness outcomes significantly over that of usual care for soldiers/family members and 2) determine the risk factor and chronic disease profile of soldiers/family members. A two group, randomized comparative posttest design will assign 4208 soldiers/family members to either an experimental or control group. It is hypothesized that access, utilization, satisfaction, clinical effectiveness, and cost-effectiveness will increase when health promotion/disease prevention services are PCNL coordinated, and PPIP guideline/protocol-based versus when these services are not coordinated by the PCNL using PPIP guidelines /protocols. Two primary care clinics, the Health Enrollment Assessment Review survey, electronic medical information systems, and two mail surveys will serve as data sources. Findings will facilitate the best coordination practices and delineate a role for the military nurse that objectively contributes to improved primary care quality and cost outcomes.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013104...