Stanton Marietta, Dunkin Jeri
Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL 35487, USA.
Prof Case Manag. 2009 Nov-Dec;14(6):321-7. doi: 10.1097/NCM.0b013e3181c3d405.
PURPOSE/OBJECTIVES: Case management activities were reviewed in a rural, nurse-managed, primary healthcare setting over 3 months. The purpose was to determine the specific case management tasks and how these functions related to, or enhanced, lateral transitions in care. The transition from outpatient to inpatient care implies a vertical transition of care, as the care at the hospital level is more complex than in a physician's office. Many times, patients will move between different providers and clinics in the outpatient (or inpatient) setting; these are considered lateral transitions. In a nurse-managed clinic, there are many referrals, hence many handoffs. As these patients move to and from these appointments and referrals, new tests are conducted and new medication may be ordered. To maintain a high quality of care, new therapies and medications must be integrated into the plan of care.
PRIMARY PRACTICE SETTING(S): This study was conducted in a rural, nurse-managed, primary healthcare setting; however, the results are generalizable across many settings.
FINDINGS/CONCLUSIONS: In this study, it was determined that the case managers were managing the transitions between the clinic and other outpatient services, as well as managing and ordering the patient's medications and therapies. Approximately 45%-50% of case management functions involved either obtaining medication assistance for patients without funding or assisting patients with the ordering and procurement of essential medicines. Another 45% of the case manager's time was spent coordinating referrals to a wide variety of specialty clinics for diagnostic testing, obtaining appointments with community-based family practice physicians, or coordinating examinations for specialty physicians.
Transitions in care have become a major focus in promoting patient safety. Case managers at the primary, secondary, and tertiary levels of care play a major role in making these transitions safe, whether these transitions are vertical or lateral. Safety issues come into play as patients move back and forth--or up and down--in the system, because providers do not always manage the safe handoff of the patient to other outpatient or inpatient services.
目的/目标：在一个乡村、由护士管理的基层医疗环境中，对病例管理活动进行了为期3个月的审查。目的是确定具体的病例管理任务，以及这些职能如何与护理中的横向过渡相关或促进横向过渡。从门诊护理到住院护理的转变意味着护理的纵向过渡，因为医院层面的护理比医生办公室的护理更复杂。很多时候，患者会在门诊（或住院）环境中的不同提供者和诊所之间转诊；这些被视为横向过渡。在由护士管理的诊所中，有很多转诊，因此有很多交接。当这些患者往返于这些预约和转诊时，会进行新的检查，并可能开出新的药物。为了保持高质量的护理，新的治疗方法和药物必须纳入护理计划。
本研究在一个乡村、由护士管理的基层医疗环境中进行；然而，研究结果在许多环境中具有普遍性。
研究结果/结论：在本研究中，确定病例管理人员负责管理诊所与其他门诊服务之间的过渡，以及管理和订购患者的药物及治疗。大约45%-50%的病例管理职能涉及为没有资金的患者获取药物援助，或协助患者订购和采购基本药物。病例管理人员另外45%的时间用于协调转诊到各种专科诊所进行诊断测试、预约社区家庭医生，或协调专科医生的检查。
护理过渡已成为促进患者安全的主要关注点。在初级、二级和三级护理层面的病例管理人员在确保这些过渡安全方面发挥着重要作用，无论这些过渡是纵向还是横向。当患者在系统中来回或上下移动时，安全问题就会出现，因为提供者并不总是安全地将患者交接给其他门诊或住院服务。
