到底的竞赛:一个高体积的医院经验,全面的关节置换护理
John M Dundon1, Nicholas C Brown2, Lauren Gogel3
1Orthopaedic Research Institute of New Jersey, Chester, New Jersey; Department of Orthopedic, Morristown Medical Center, Morristown, New Jersey.
The Journal of arthroplasty
|October 29, 2025
概括
综合关节置换护理 (CCJR) 计划改善了整体关节整形术 (TJA) 护理的质量,但由于退款减少而面临财务挑战. 尽管重新入院和熟练护理设施的使用减少了,该计划仍在继续.
科学领域:
- 整形外科手术 整形外科手术
- 医疗保健管理的管理
- 以价值为基础的护理
背景情况:
- 关节置换综合护理 (CCJR) 倡议旨在提高全关节形术 (TJA) 病例的质量和降低成本.
- 这一以价值为基础的计划为医疗保健提供者引入了财务风险和激励措施.
- 了解CCJR对临床和财务结果的影响至关重要.
研究的目的:
- 评估CCJR计划对TJA事件的结果.
- 评估计划对质量指标,成本和财务协调的影响.
- 为了确定CCJR在偿还减少的情况下的长期可持续性.
主要方法:
- 成立了一个多学科的CCJR团队,包括护理协调员,护士导航员,医生和财务专家.
- 定期会议和小组分析的重点是患者优化,再接收,熟练护理设施 (SNF) 的利用和患者教育.
- 使用统计分析,包括奇平方测试,来评估关键绩效指标的变化 (P < 0.05).
主要成果:
- 熟练护理设施的利用率大幅下降,从28.8%降至6.7% (P < 0.00001).
- 再接收率从7.4%下降到4.1% (P < 0.001). 在美国,再接收率从7.4%下降到4.1% (P < 0.001).
- 虽然每病例的初始平均调和为正值 (2798.54美元),但到最后一年,它变得负值 (163.75美元),导致净损失为255,621.54美元.
结论:
- 尽管补偿金减少,但CCJR计划在TJA事件期间成功改善了质量指标.
- 持续的质量改进需要增加人员,这影响了财务可行性.
- 长期来看,CCJR内部不断下降的报销结构在财务上是不可持续的.
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