Lee Keon-Hyung, Davenport Laura
Department of Health Professions, College of Health and Public Affairs, University of Central Florida, Orlando, FL 32816-2205, USA.
Health Care Manag (Frederick). 2006 Apr-Jun;25(2):155-9. doi: 10.1097/00126450-200604000-00008.
This study examined the impact of nurse case management interventions on the number of visits of frequent users of a level 1, urban Emergency Department that sees over 70,000 patient visits per year. Frequent users, defined as those having over 3 visits in a month, were tracked before and after implementation of nurse case management interventions designed to reduce their visit rate. It is a 50-patient pilot study and data collection includes whether or not the patient had a primary care provider, the patient's age and gender, insurance status, and the type of case management interventions including medical social work, community referrals, referrals to primary care providers, and limitation of narcotic prescriptions. Based on statistical tests, pre and post case management interventions suggest that case management interventions do not make a statistically significant reduction in the overall number of visits. This is a medically vulnerable patient group whose visits add to the contemporary problem of Emergency Department overcrowding. The ability of case management interventions to reduce the volume of visits and associated impact on reducing Emergency Department overcrowding was not proven.
本研究调查了护士病例管理干预措施对一家一级城市急诊科频繁就诊患者就诊次数的影响，该急诊科每年接待超过70000名患者就诊。频繁就诊患者定义为一个月内就诊超过3次的患者，在实施旨在降低其就诊率的护士病例管理干预措施之前和之后对他们进行跟踪。这是一项有50名患者的试点研究，数据收集包括患者是否有初级保健提供者、患者的年龄和性别、保险状况，以及病例管理干预措施的类型，包括医疗社会工作、社区转诊、转诊至初级保健提供者，以及限制麻醉处方。基于统计测试，病例管理干预措施实施前后的情况表明，病例管理干预措施并未使就诊总数在统计学上显著减少。这是一个医疗上易受伤害的患者群体，他们的就诊加剧了当前急诊科过度拥挤的问题。病例管理干预措施减少就诊量的能力以及对减少急诊科过度拥挤的相关影响尚未得到证实。
