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 services on hospital use and costs for elderly people in a health maintenance organization (HMO). We tracked 4,943 HMO patients over three consecutive 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 4,316 nonprogram patients in respect to their utilization and costs during periods 2 and 3. Regression results reveal that patients receiving integrated services had significantly higher utilization and costs during the period of enrollment and significantly lower utilization and costs during the period following enrollment, compared to nonprogram patients. These results were replicated when considering only patients with observed episodes of care in these periods, when controlling for hospital use and costs in the prior period, and when controlling for the risk of selection into the program. The findings suggest that integrating services at the community level may achieve substantial cost savings.