Pinzur Michael S, Gurza Edward, Kristopaitis Theresa, Monson Rebecca, Wall Michael J, Porter Anne, Davidson-Bell Victoria, Rapp Timothy
Department of Orthopedic Surgery, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL 60153, USA.
Orthopedics. 2009 Jul;32(7):495. doi: 10.3928/01477447-20090527-14.
The introduction of the hospitalist co-management model represents an opportunity to improve care by changing the system as it applies to a small group of patients. Eighty-six consecutive patients with multiple comorbidities were selectively enrolled in an academic medical center hospitalist-orthopedic surgery co-management patient care program. Patients were stratified by all patient refined diagnosis-related groups, severity of illness, and risk of mortality. Hospital length of stay, cost of care, in-hospital mortality, complications, and intensive care unit admissions were compared with a retrospectively constructed control group of 54 patients undergoing similar surgery during the period immediately preceding initiation of the program. The University Health System Consortium observed-to-expected ratio for hospital length of stay was 0.693 compared to 0.862 for the control group. The severity of illness and risk of mortality scores represented a relatively higher risk stratification in the study group. While the overall observed-to-expected cost of care remained virtually unchanged, the positive impact of the study model revealed an increased positive effect on the more severely affected severity of illness and risk of mortality patients. The results of this study suggest that a proactive, cooperative, co-management model for the perioperative management of high-risk patients undergoing complex surgery can improve the quality and efficiency metrics associated with the delivery of service to patients.
引入住院医师共同管理模式为通过改变适用于一小部分患者的系统来改善护理提供了契机。在一家学术医疗中心，连续86例患有多种合并症的患者被选择性纳入住院医师 - 骨科手术共同管理患者护理项目。患者根据所有患者细化诊断相关组、疾病严重程度和死亡风险进行分层。将住院时间、护理成本、住院死亡率、并发症以及重症监护病房入院情况与在该项目启动前紧接时期内进行类似手术的54例患者的回顾性构建对照组进行比较。大学卫生系统联盟观察到的住院时间与预期住院时间之比为0.693，而对照组为0.862。研究组的疾病严重程度和死亡风险评分代表了相对较高的风险分层。虽然总体观察到的护理成本与预期成本基本保持不变，但研究模型的积极影响显示，对病情更严重、疾病严重程度和死亡风险更高的患者有更大的积极作用。这项研究的结果表明，对于接受复杂手术的高危患者，采用积极主动、合作的共同管理模式进行围手术期管理，可以改善与为患者提供服务相关的质量和效率指标。
