Nurse case management has been found to be an effective strategy toward promotion of comprehensive and cost-effective care for chronically ill and compromised patients. For this reason, this approach is of considerable interest to agencies planning community based care for persons with HIV-related illnesses. Little research is available to document the effectiveness of this delivery strategy for HIV patients, particularly as it relates to the usual evaluation measures of patient functioning, utilization of services, costs of services, and satisfaction with care. This study is a collaborative effort by the Ohio State University College of Nursing and the Columbus Health Department to compare effects of nurse case managed home care to routine home care. The study is designed as a randomized control trial with individuals assigned to case managed or routine care groups. Subjects will be admitted to the study on referral to home care, with approximately 572 subjects projected as eligible for participation during the two and one-half year period of data collection. The median duration of participation pre client is expected to be about three months. Evaluation will be based on measures of patient functional status, use of formal and informal services, costs of care, and patient/caregiver satisfaction. These outcome variables will be measured at monthly intervals and associations will be assessed through repeated cross-sectional multiple regression for the varying subject groups at varying times. Impacts of the case management intervention, patient characteristics, disease severity and treatment factors on the outcomes will be assessed, as well as interrelatedness of the outcome measures. Cost-effectiveness ratios will be calculated for the two groups with direct costs as the numerator term and a measure of well-years derived from the health status scale as the denominator. Results of the study should provide program planners with specific data relative to advantages and disadvantages of supplementary nurse case management for home care clients as well as with descriptive data necessary for projecting service needs for home care clients with HIV related illnesses.

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National Institute of Nursing Research (NINR)
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Ohio State University
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Nickel, J T; Salsberry, P J; O'Connell, M et al. (1998) Sexual activity and knowledge of safe sex reported by HIV-infected persons receiving home care. Home Healthc Nurse 16:183-92
Nickel, J T; Salsberry, P J; Caswell, R J et al. (1996) Quality of life in nurse case management of persons with AIDS receiving home care. Res Nurs Health 19:91-9
Salsberry, P J; Nickel, J T; O'Connell, M (1991) AIDS research in the community: a case study in collaboration between researchers and clinicians. Public Health Nurs 8:201-7