Waszynski C M, Murakami W, Lewis M
Care Manag J. 2000 Fall;2(3):148-52.
A group of advanced practice nurses partnered with a major insurer in the design and implementation of a care coordination model for high-risk older adults. This article will discuss the process of such an undertaking, highlighting the successes and barriers encountered. The key elements of this program included early identification and regular reassessment of each member's acuity level; fostering close partnerships between individual or teams of APRNs and groups of physicians; and uninterrupted clinical management of high-risk members across the health care continuum. This model was designed to achieve the following outcomes: to support the physician management of high-risk, chronic individuals; to increase or maintain the health of members; and to reduce health care costs. Outcome studies have demonstrated a substantial net savings by decreasing acute care admissions by 54%, reducing hospital days by 42%, and trimming primary care physicians' and specialists' visit costs by 37%. There was a 33% reduction in the overall costs of health care for members enrolled in this program. Physicians and members both rated their satisfaction with the APRN-based model of care as very high.
一群高级执业护士与一家大型保险公司合作，设计并实施了针对高危老年人的护理协调模式。本文将讨论这一工作的过程，重点介绍所取得的成功和遇到的障碍。该项目的关键要素包括对每个成员的 acuity 水平进行早期识别和定期重新评估；促进 APRN 个人或团队与医生群体之间建立密切的伙伴关系；以及在整个医疗保健连续过程中对高危成员进行不间断的临床管理。该模式旨在实现以下成果：支持医生对高危慢性患者的管理；提高或维持成员的健康水平；以及降低医疗保健成本。结果研究表明，通过将急性护理入院率降低 54%、减少住院天数 42%以及将初级保健医生和专科医生的就诊成本削减 37%，实现了大幅净节省。参加该项目的成员的医疗保健总成本降低了 33%。医生和成员对基于 APRN 的护理模式的满意度都很高。
