Nurses can help reduce hospital admissions in patients with chronic illnesses, according to two recent studies, and one nurse-led program reduced health care costs as well.

Project RED. Jack and colleagues designed Project RED (Re-Engineered Discharge) to improve the transition from hospital to home. Nurses trained as "discharge advocates" informed patients about their illnesses and medications and coordinated discharge and follow-up visits with the patients' physicians and hospital team. The nurses also created individualized "after hospital care plans," booklets that included provider contact information, dates for appointments and tests, color-coded medication schedules, and instructions in case of an emergency. The nurse gave patients a copy of the booklet at discharge and sent a copy to the physician.

Within 30 days of discharge, hospital readmissions and ED visits were reduced by 30% and total costs were lowered by 34% among 370 patients enrolled in Project RED, compared with 368 patients discharged normally. The difference in total costs (ED, hospital, and physician visits) between the groups was nearly $150,000, with Project RED patients spending $412 less on average per person. (For information on the discharge advocate training program and the care plan booklet, click on "Toolkit" at http://bit.ly/AnWw8.)

Nurses as care coordinators. A study funded by the Centers for Medicare and Medicaid Services met with mixed success. Peikes and colleagues independently assessed data from 15 demonstration programs designed to improve care and cut Medicare costs in chronically ill patients. Nurses trained as care coordinators educated and monitored patients largely by telephone. Twice a month, on average, they called to urge them to take their medications and to advise them on diet and exercise.

The nationwide program involved 18,000 patients at community hospitals, academic medical centers, nursing homes, and other settings. Most patients had heart disease, chronic lung disease, and diabetes. After three years, two sites had reduced hospitalizations by 17% and 24%, but admissions rose by as much as 19% at others. None lowered Medicare expenses; in some, costs rose by as much as 45%.

At the two sites that reduced hospitalizations, care coordinators met with patients in person rather than just on the telephone. They also informed patients about their medications and attended physician visits. Despite the limited overall success, the positive results at two sites "suggest that the potential exists for care coordination interventions to be cost-neutral and to improve patients' well-being," the authors write.

Both studies highlight the capacity of nurses "to interrupt patterns of poor care and improve outcomes," says Mary Naylor, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. "We should take advantage of evidence from studies that point to how nurses can have an impact on chronically ill patient populations."

Jack BW, et al. Ann Intern Med 2009;150 (3):178-87; Peikes D, et al. JAMA 2009;301(6):603-18.

Carol Potera