Outcomes based care delivery:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Critical care nursing clinics of North America
10,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 158 S. Ill., graph. Darst. |
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| 650 | 2 | |a Évaluation résultats et méthodes (soins) | |
| 650 | 4 | |a Outcome Assessment (Health Care) | |
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Datensatz im Suchindex
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| adam_text | Outcomes Based Care Delivery
Contents
Preface xiii
S. Jill Ley
Historical Development of Outcomes Based Care Delivery 1
Karen Zander
Outcomes in health care are the discreet, measurable, itemized results of clinical interventions. As
such, their formal use by non research providers has evolved and increased dramatically over the
last 20 years, largely owing to market forces demanding decreased cost with the same or increased
level of quality. This article describes the historical development of outcomes based care delivery; a
glossary of terms is also included at the end of the article.
The Vanderbilt Model of Outcomes Management 13
Susan M. Erickson
Outcomes management is a powerful process for defining, monitoring, and continuously improving
practice to enhance the health status of patients. Outcomes management provides patients, providers,
and payers with objective data that enhances decision making about medical care. Case management
programs can play an integral role in supporting hospitals and provides efforts to define, measure,
and manage outcomes. New skills and support systems are required to do this work well, and
successful efforts will reflect careful planning and implementation. The key concepts of outcomes
management, how these relate to case management and a case study describing one organization s
experience in bringing these efforts together are described.
The Clinical Resource Management Model 21
Toni Propotnik
The clinical resource management model extends traditional utilization management functions to
encompass clinical care management, resource management, outcomes management, and quality
management, along with utilization review, discharge planning, and the provision of social services.
The model focuses on following patient populations across the continuum, providing quality, cost
effective care in a collaborative manner. This is an empowering model that exemplifies multidiscipli
nary planning at its best. Team members take pride in determining and providing care according to
their own defined best practices and collecting and reporting variances from best practices. These
variances serve as the focus of process quality improvement for the organization.
Longitudinal Outcomes Measurement and Management:
Standardizing Practices Across the Continuum of Care 33
Anne W. Wojner and Mark A. MacCutcheon
Longitudinal outcomes measurement involves collection of outcomes data across a continuum of
care services in a patient cohort. This article reviews outcomes measurement and management, long
CRITICAL CARE NURSING CLINICS OF NORTH AMERICA
Volume 10 / Number 1 / March 1998 ix
term outcomes, intermediate outcomes and variances, longitudinal measurement, and measurement
considerations within the post acute continuum.
The Concept and the Development of Chest Pain Emergency
Departments as a Strategy in the War Against Heart Attack 41
Raymond D. Bahr
Chest pain emergency departments CCPEDs) focus on equating priority with severity. In the past,
patients experiencing heart attacks may have typically presented to emergency departments with
cardiac arrest, pulmonary edema, and cardiogenic shock, but this presentation has changed in recent
years. Patients now come in earlier, experiencing chest pain and milder forms of chest discomfort.
They need immediate evaluation to prevent the above problems from developing. This article reviews
the CPED strategy that places special emphasis on these patients and a changing attitude on the part
of health care providers to make thoughtful, cost effective, high quality care decisions.
Outcomes Management for Interventional Cardiology 53
Vicki J. Coombs
It is estimated that approximately 398,000 interventional cardiology procedures are performed in the
United States each year. This volume of procedures mandates efficient, high quality, and cost effective
health care for patients with cardiovascular disease. Outcomes management serves as a guide for
meeting the physical, functional, service, quality, and financial needs of patients and their families.
This article describes the components of outcomes management in interventional cardiology.
Port Access Cardiac Surgery Protocols and Early Outcomes 61
James Philip Rogers, Terry M. Novchich, Gregory L. Pearce,
Joanne S. Johnston, Harry G. Burton, and Mark A. Groh
Port access cardiac surgery is being used successfully in conjunction with a clinical pathway that
incorporates aggressive collaborative practice protocols. The protocols are designed to facilitate early
extubation of the patient, encourage mobilization, and shorten the hospital length of stay (LOS).
Patient planning begins preoperatively and includes the patient and his or her family. Postoperative
follow up ensures that patient concerns are appropriately addressed, given the shortened recovery
time permitted by the procedure.
Impact of a Critical Care Pathway for Unstable Mechanically
Ventilated Patients 75
Barbara J. Price, Gordon R. Bernard, Kathleen Drew, Julie Foss,
and Arthur P. Wheeler
This article describes outcomes oriented care through the development and implementation of a
multidisciplinary critical pathway for the patient with hemodynamic or respiratory instability. The
pathway outlines high quality care based on practice guidelines designed to maintain or improve
outcomes while minimizing the financial burden to the institution. This article focuses on critical
pathway development and implementation, includes specific goals and interventions for each phase of
illness, and describes the multidisciplinary process used in conjunction with pathway implementation.
Evidence based practice changes were based on the literature and resulted in streamlined nursing
documentation, demonstration of quality outcomes, highlighting the value of the pathway as a cost
efficient tool.
The Long Term Mechanically Ventilated Patient: An Outcomes
Management Approach 87
Suzanne M. Burns
Negative outcomes associated with long term mechanical ventilation include high care costs; high
mortality and iatrogenic complications; and low patient, family, and staff satisfaction, tn an effort to
defray costs and improve quality, numerous system redesign efforts have been proposed. One such
system is outcomes management. This article reviews the current knowledge related to use of outcomes
management and other similar care delivery models such as case management, which are designed
for patients requiring prolonged ventilation.
Outcomes Management for Stroke Patients Using Thrombolytics 101
Janice L. Hickman
Outcomes for acute ischemic stroke can be improved with the use of thrombolytics if these agents
are administered early to patients who meet the criteria. As with heart attacks, time is essential in
X CONTENTS
successful treatment of a brain attack with thrombolytics. The development of a committed stroke
team and protocol is necessary if protocol implementation is to be effective. The implementation of
stroke pathways and protocols as well as specific outcomes with their use are discussed in this article.
Impact of Technology on Costs and Patient Outcome 117
Tom Ahrens
This article reviews the current state of technology usage, along with steps necessary to improve this
state. These steps include understanding the required concepts necessary for acquiring and using
technology, as well as the potential impact using technology will have on costs. Specific clinical
applications common to critical care nursing are also presented.
Integration of Acute Care CNS and Case Manager Roles 127
Margaret M. Conger
The movement towards a managed health care system has resulted in reduced demand for clinical
nurse specialists. A new role for these clinically competent nurses that has emerged is that of nurse
case manager. This article discusses the role differences between the clinical nurse specialist and the
nurse case manager and suggests areas of educational importance for a successful transition from
one role to the other. More than just learning new skills, the clinical specialist needs to undergo
perspective transformation to function effectively in the new reality of managed care.
Patient Advocacy Through Outcomes Management: A Cardiac
Surgery Example 135
S. Jill Ley
Rapid changes in health care have contributed to the need for developing nursing practices that are
outcome based. Additionally, these changes have resulted in increasing use of nurses as patient
advocates. This article describes how these roles can be achieved together. Data is a powerful tool
that can educate, validate, and serve as a catalyst for change. A comprehensive outcomes management
program is presented for the cardiac surgery population that addresses quality of care through ongoing
processes of inquiry. Patient focused practices of early extubation and blood conservation emphasize
the role of information management in care delivery that enhances positive clinical and financial out¬
comes.
Index 155
Subscription Information Inside back cover
CONTENTS Xi
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