HOSPITAL BASED MANAGED CARE: COST AND QUALITY

管理型医疗，多年来一直用于提高初级保健的效率 卫生服务，是作为一种提高效率的方式提出的 医院护理。这种以医院为基础的管理型医疗(HBMC)干预是 旨在通过消除多余的患者护理来提高效率 组件，同时保持护理和患者的有效性 护理的满足感。HBMC干预包括多个- 纪律CareMap(Tm)，包括关键护理组件和患者 特定的一组患者，即诊断组， 还有一位护士长。护士病例经理协调多个- 开发CareMap(Tm)的纪律团队，监督 实施地图，提供员工教育，并监控患者 进步。本研究项目是HBMC剖腹产的初步试验 患者，为在整个过程中实施和测试HBMC做准备 机构。 用于试点测试的人群将是所有患有 剖腹产是美国最常见的手术。一群人 将使用准可比较组(N=200)进行研究，以确定 干预对住院天数、费用、病人的影响 结果和满足感。HBMC将于1992年7月1日开始实施， 并将给所有员工两个月的时间来改变他们的做法 与地图保持一致。将被比较的组是一个对照 1992年1月至1992年6月剖宫产组； 另一组为实验组，1992年9月开始剖腹产 一直到1993年3月。培训护士病历管理员的程序， 开发和实现CareMaps(Tm)，并评估 地图也将被评估。

Managed care, used for many years to increase efficiency in primary health services, is proposed as a way of increasing efficiency in hospital care. This Hospital Based Managed Care (HBMC) intervention is designed to increase efficiency by eliminating redundant patient care components while maintaining effectiveness of care and patient satisfaction with care. The HBMC intervention consists of a multi- disciplinary CareMap(tm) that includes key care components and patient problems common to a specific group of patients, i.e. diagnostic group, and a Nurse Case Manager. The Nurse Case Manager coordinates a multi- disciplinary team that develops the CareMap(tm), supervises the implementation of the map, provides staff education, and monitors patient progress. This research project is a pilot test of HBMC with C-section patients, preparatory to implementing and testing HBMC throughout the institution. The population used for the pilot test will be all patients with C-section, the most commonly performed surgery in the US. A cohort study, with quasi-comparable groups (N=200), will be used to determine the effects of the intervention on the length of stay, costs, patient outcomes, and satisfaction. HBMC will be implemented on July 1, 1992, and two months will be allowed for all staff to alter their practice to conform with the map. The groups that will be compared are a control group, patients having C-sections from January, 1992, through June, 1992; and an experimental group, patients having C-section from September, 1992 through March, 1993. The procedures for training nurse case managers, developing and implementing CareMaps(tm), and assessing the variance from the map will also be evaluated.