There is increasing awareness amongst clinicians and health policymakers that integrated models of care are important, particularly in complex, multi-faceted diseases such as Parkinson’s disease (PD). Unfortunately, several questions remain unknown including which specific components of care are needed to improve patient-centered outcomes, how to best deliver coordinated care and what are the costs. Connor and colleagues compared a nurse-led care management intervention against usual care in PD to better understand these gaps in knowledge.
The guided care management intervention in this randomized, controlled trial was led by nurse case managers who coordinated with the site clinicians to administer structured assessments, guideline-based care protocols, documentation templates and enhanced communication tools. The nurse case managers followed-up with patients by telephone calls at regular intervals to monitor how patients were doing. The principal findings were that care received by veterans in the intervention arm were more likely to meet PD quality indicators than those in the standard of care arm. However, important, patient-centered, secondary outcomes with the exception of improvement in depression symptomatology did not differ between groups. This study provides strong evidence that nurse case managers are helpful in coordinating, high-quality care in PD, but the impact of this care coordination on patient-centered outcomes is weaker.
Studies such as this one are exceedingly difficult to fund and execute given the time, personnel and assessments involved, but at the same time incredibly important so that we can improve how we deliver complex neurological care. This study highlights several key issues in the study and implementation of multi-disciplinary care models in PD. One is, how do we compare outcomes across groups when care is personalized to the individual? When the intervention is personnel-based, can we identify the minimum level of training/expertise required to provide high quality care? What are the costs of this type of care? And, ultimately, which components of coordinated care provide the highest value?