A multimethod study of advanced practice nurse postdischarge care.

In the United States, increasing emphasis is being placed on understanding the roles and cost-effectiveness of advanced practice nurses (APNs). This study used both quantitative and qualitative strategies to explore the impact of APN intervention for frail rural elders being discharged from the hospital. For the quantitative component, analyses of specific postdischarge elder (n = 140) and caregiver (n = 65) outcomes were conducted using four groups receiving the following types of care: no nursing care, registered nurse (RN) care only, APN care only, and both RN and APN care. Outcomes assessed included elder cognitive functioning, self-rated health, informal services provided, and use of health care resources. Caregiver outcomes included physical, emotional, and depressive symptoms, as well as stress scores, physician visits, and missed work days. Elders in the APN-only group experienced fewer emergency room visits and hospital readmissions, although the difference was not significant. Caregivers receiving APN-only support reported significantly fewer work days missed. For the qualitative component, a focus group with four APNs who delivered the intervention was conducted to explore unique aspects of their roles and specific interventions they provided. A theme of these results was more comprehensive and autonomous delivery and management of care to both elders and their caregivers.