精准病例管理模式在加拿大住院康复中心的实施:质量改进项目实施后12个月的结果。

IF 1.6 Q3 HEALTH POLICY & SERVICES Health Services Management Research Pub Date : 2023-08-01 DOI:10.1177/09514848221109832
Michael Chislett, Karen Hurtubise, Jason McCarthy, Cathy Hoyles
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引用次数: 0

摘要

尽管有这些建议,但在积极监测功能结果的同时,很少有关于实施康复住院时间基准的质量改进倡议的报道。本文描述了在加拿大一家机构的所有住院康复客户群体中精确病例管理模型的开发、实施和评估。为了制定康复停留时间(LoRS)基准,对患者数据进行回顾性分析。采用严重程度特异性方法对中位住院时间进行分层。目标是减少8.6天的LoRS。通过功能独立性测量(FIM®)设定和监测功能放电目标。实现使用了一种渐进式质量改进分阶段方法。12个月后,在所有康复客户组中,平均LoRS减少了13.2天,具有统计学意义,FIM®变化也有小幅增加。在三个主要客户组中也看到了类似的模式,在这些客户组中,LoRS的减少幅度超过了目标,同时LoRS的效率也得到了重要提高。本研究展示了精确病例管理模型的实施如何帮助机构在不影响功能变化或社区出院率的情况下显著减少住院患者群体的LoRS,并开始向基于价值的组织转型。
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The implementation of a precision case management model in a Canadian inpatient rehabilitation center: The 12-months post-implementation findings of a quality improvement project.

Despite recommendations, few have reported on quality improvement initiatives to implement length of rehabilitation stay benchmarks, while actively monitoring functional outcomes. This article describes the development, implementation, and evaluation of a precision case management model across all inpatient rehabilitation client groups in a Canadian facility. To develop the length of rehabilitation-stay (LoRS) benchmarks, patient data was retrospectively analyzed. A severity specific method was used to stratify median length of stay. A target reduction on 8.6 days in LoRS was established. Functional discharge targets were also set and monitored at specific intervals via the Functional Independence Measure (FIM®). The implementation used an incremental quality improvement phased approach. Following 12-months, a statistically significant reduction in mean LoRS of 13.2 days was achieved, along with a small increase in FIM® change across all rehabilitation client groups. A similar pattern was seen across the three main client groups, where a LoRS reduction greater than the target was achieved, along with important improvements in LoRS efficiency. This study demonstrates how the implementation of a precision case management model can assist a facility in markedly reducing LoRS across inpatient groups, without compromising functional change or community discharge rates and begin its transformation to a value-based organization.

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来源期刊
Health Services Management Research
Health Services Management Research HEALTH POLICY & SERVICES-
CiteScore
4.00
自引率
4.80%
发文量
33
期刊介绍: Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.
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