Grand-Aides make nursing go further

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Alexandra Wilson Pecci, for HealthLeaders Media, May 22, 2012

When I'm sick, there are a handful of people who I'd want to take care of me, and my grandmother is chief among them.

That's the idea behind Grand-Aides, a corps of trained community members who act as "nurse extenders" by transmitting information and instructions back and forth between patients and nurses. They are directly supervised by nurses and can conduct telephone consultations or make home visits to patients.

It's all done in an effort to reduce the number of visits to EDs, clinics, and hospitals by people who can actually be cared for at home.

Grand-Aides don't do any decision-making themselves in providing patient care, says Arthur Garson, Jr., MD, MPH, president and CEO of The Grand-Aides Foundation and director of the Center for Health Policy at the University of Virginia.

Instead, they get instructions from a nurse supervisor who manages five to six Grand-Aides, he tells HealthLeaders Media. Grand-Aides collect data about patients to report back to their nurse supervisors. Then, the supervisor instructs the Grand-Aide in providing care instructions to the patients.

In a primary care setting, Grand-Aides will provide telephone triage for primary care conditions; they might give advice over the phone or make home visits, always under the instruction of the nurse supervisor. For transitional or chronic care, Grand-Aides go home from the hospital with chronic disease patients and help them with things like medication adherence and sticking with their treatment plan. They also use telemedicine tools so nurse supervisors can "see" the patients themselves, too.

The Grand-Aide "becomes a communicator and router" for relaying patient information to nurses, "getting it in a way that takes less time," Garson says.

And in a way that takes less money, too, according to a Health Affairs study published this month. The study examined pilot tests with Grand-Aides in two pediatric Medicaid settings, one of which was an urban federally qualified health center in Houston.

Researchers found that that the cost of the Grand-Aides program is $16.88 per encounter, compared to current Medicaid payments of $200 per clinic visit in Houston. Researchers estimated that Grand-Aides and their supervisors averted 62% of drop-in visits at the Houston clinic. None of the patients in the study visited the ED.

Grand-Aides must be state-certified as either Certified Nurse Aides or Certified Medical Assistants, or Certified Community Health Workers, because, as Garson says, "we thought it was very important to start with a known quantity."

They then receive additional training on the Grand-Aides curriculum, which consists of learning basic medical and disease-specific knowledge and a preceptorship. They're employed by clinics, and sometimes directly by hospitals or home health agencies; the state of Texas has placed the Grand-Aides program into the Medicaid program.

Grand-Aides aren't necessarily grandparents—that would be discriminatory against non-grandparents—but they do have the characteristics of a grandparent: mature, caring, trusted. In fact, that's how Grand-Aides began.

"This whole idea started about 15 years ago," Garson says, "when the chair of family medicine said to me that 50% of his patients could be taken care of by a good grandmother."

Source: HealthLeaders Media