开发一个紧急部门案例管理案例查找工具的开发
David Gallagher1,2,3,4,5,6,7,8,9, Barbara Bentley1,2,3,4,5,6,7,8,9, Ashley Barry1,2,3,4,5,6,7,8,9
1David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist.
新的急诊部病例管理优先评分 (EDCMPS) 有效地识别了高风险患者的复诊. 这种电子医疗记录工具提高了病例管理效率,并得到了员工的强有力的支持.
科学领域:
- 医疗保健管理的管理
- 提高质量 提高质量
- 患者的治疗结果.
背景情况:
- 识别急诊室 (ED) 重复访问的高风险患者对于有效的病例管理至关重要.
- 改善患者护理和减少医疗保健利用需要有效的患者识别系统.
研究的目的:
- 开发和评估急诊部病例管理优先评分 (EDCMPS),这是一个基于电子病历 (EMR) 的系统,用于识别高风险ED患者.
- 评估EDCMPS在紧急部门案例经理 (ED CM) 中的可接受性和性能.
主要方法:
- 追溯分析比较了杜克大学医院EDCMPS实施前和后的患者数据.
- 开发EDCMPS使用LEAN和Plan-Do-Study-Act (PDSA) 方法与ED CM输入.
- 7日和30日ED回归和住院率的比较;调查评估CM满意度.
主要成果:
- 与手动方法 (10.3%) 相比,EDCMPS确定了较低的高风险患者比例 (5.1%),但对于7天和30天的返回预测值显著更高 (例如,30天OR=4.21对1.69).
- EDCMs普遍认为EDCMPS的表现优于手动方法,特别是在组织资源和推方面.
- 发现的挑战包括确保初级保健后续,住房和保险申请.
结论:
- EDCMPS在提高ED案件管理效率方面表现有前途,并得到了前线工作人员的强烈认可.
- 该工具可以确定患者支持的领域,并可能减少ED重访和医疗保健利用.
- 该方法为其他医疗保健机构的类似实施提供了一个框架.
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