Doerge J B
Mercy Hospital Medical Center, Des Moines, Iowa 50314-3190, USA.
Outcomes Manag Nurs Pract. 2000 Jan-Mar;4(1):28-33.
Four constructs used to build a framework for outcomes management for a large midwestern tertiary hospital are described in this article. A system framework outlining a model of clinical integration and population management based in Steven Shortell's work is discussed. This framework includes key definitions of high-risk patients, target groups, populations and community. Roles for each level of population management and how they were implemented in the health care system are described. A point of service framework centered on seven dimensions of care is the next construct applied on each nursing unit. The third construct outlines the framework for role development. Three roles for nursing were created to implement strategies for target groups that are strategic disease categories; two of those roles are described in depth. The philosophy of nursing practice is centered on caring and existential advocacy. The final construct is the modification of the Dartmouth model as a common framework for outcomes. System applications of the scorecard and lessons learned in the 2-year process of implementation are shared
本文介绍了用于为一家大型中西部三级医院构建结果管理框架的四个构建要素。讨论了一个基于史蒂文·肖特尔的工作概述临床整合和人群管理模型的系统框架。该框架包括高危患者、目标群体、人群和社区的关键定义。描述了人群管理各层面的作用以及它们在医疗保健系统中的实施方式。以护理的七个维度为中心的服务点框架是应用于每个护理单元的下一个构建要素。第三个构建要素概述了角色发展框架。创建了三个护理角色来实施针对作为战略疾病类别的目标群体的策略；其中两个角色进行了深入描述。护理实践理念以关怀和生存倡导为中心。最后一个构建要素是将达特茅斯模型修改为结果的通用框架。分享了记分卡的系统应用以及在两年实施过程中吸取的经验教训。
