Hosp Case Manag. 1999 Jan;7(1):3-5.
Faced with a case-mix index they knew was too low for their facility, administrators at Vanderbilt University Hospital in Nashville, TN, set about formulating a new, integrated case management model stressing that case management is a process rather than a role. Under the new model, the hospital's old-fashioned utilization review department was brought out of the basement and transformed into a team of utilization management/DRG management professionals who perform concurrent chart reviews and actively manage DRGs, making sure supporting documentation adequately reflects patient severity. The model, based on "triads" of case managers, social workers, and UM staff, allows for some flexibility when responsibilities overlap, yet each professional maintains a separate and distinct focus within the group.
田纳西州纳什维尔范德比尔特大学医院的管理人员面临着一个他们知道对自己医院来说过低的病例组合指数，于是着手制定一种新的综合病例管理模式，强调病例管理是一个过程而非一个角色。在新模式下，医院老式的利用情况审查部门从地下室搬了出来，转变为一个由利用情况管理/诊断相关分组（DRG）管理专业人员组成的团队，他们进行同步病历审查并积极管理DRG，确保支持性文件充分反映患者的病情严重程度。该模式基于病例管理人员、社会工作者和利用情况管理（UM）人员组成的“三人小组”，在职责重叠时具有一定灵活性，但每个专业人员在团队中仍保持各自独立且明确的重点。
