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The purpose of this research was to investigate the impact of a nursing case management model versus a traditional modified primary care model on quality of care. Quality of care in this study was defined (by the provider) as length of stay, (by the client) as patient satisfaction and (by the professional) as meeting outcomes of appropriate clinical standards of care.

The study used a quasi-experimental design on the experimental (case managed) and control (modified primary care) groups. A non-random sample was selected for the patient population due to existing hospital protocol. The sample consisted of 100 patients (641 total patient days) who had elective orthopedic surgery and were hospitalized in an acute care setting.

The objectives of this study were met by collection of demographic data, length of stay data, and related complications information. This information plus outcome measurement data was collected on an Outcomes Measurement form. Patient satisfaction data was obtained by telephone survey using the structured format of the Press Ganey Patient Satisfaction Survey.

Data was analyzed with descriptive and inferential statistics. Frequencies were run on the data, as well as a "two-tailed" t-test for independent samples at the .05 level of significance.

In the case managed group, a significant reduction in the mean length of stay over the Diagnosis Related Group (DRG) length of stay was realized (p < .05). There was not a significant difference in the control group of patients receiving modified primary care. There was not a statistically significant difference between the groups in the patients' perception of satisfaction. There were significant differences in health outcome being met in the case managed group.

This study found that case managed patients undergoing an elective orthopedic surgical procedure in an acute care setting had a higher level of outcomes met with a reduced length of stay than non-case managed patients. Several implications for nursing, health care services and the health care reform are suggested from this study.