Pope D, Fernandes C M, Bouthillette F, Etherington J
Emergency Department, St. Paul's Hospital, Vancouver, BC.
CMAJ. 2000 Apr 4;162(7):1017-20.
The authors describe a case-management program for frequent users of the emergency department. The study had a single-subject design, with evaluation for each patient of the number of visits to the emergency department for a 12-month period before referral to the program and a similar period after implementation of an individualized care plan. Referrals were made on the basis of 2 or more of the following criteria: chronic medical condition, complex medical condition, drug-seeking behaviour, violent behaviour and abusive behaviour. A multidisciplinary team developed the individualized care plans. Twenty-four patients agreed to participate. For the 12-month period before their referral, these patients accounted for a total of 616 (median 26.5) visits to the emergency department; for a similar period after implementation of the care plans, they accounted for 175 (median 6.5) visits. The difficult-case management program appeared to be effective in reducing the total number of visits to the emergency department during the study period and in improving the care for these patients.
作者描述了一项针对急诊科频繁就诊患者的病例管理项目。该研究采用单病例设计，对每位患者在转诊至该项目前12个月内的急诊科就诊次数以及实施个性化护理计划后的类似时间段内的就诊次数进行评估。转诊基于以下2项或更多标准：慢性疾病、复杂疾病、药物寻求行为、暴力行为和辱骂行为。一个多学科团队制定了个性化护理计划。24名患者同意参与。在转诊前的12个月里，这些患者总计前往急诊科就诊616次（中位数为26.5次）；在护理计划实施后的类似时间段内，他们就诊175次（中位数为6.5次）。该疑难病例管理项目似乎在减少研究期间急诊科就诊总次数以及改善对这些患者的护理方面有效。
