Department of Marketing, Texas A&M University, College Station, TX 77843-4112, USA.
Mayo Clin Proc. 2013 Feb;88(2):184-94. doi: 10.1016/j.mayocp.2012.10.016. Epub 2013 Jan 4.
Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon.
具有最复杂健康状况的患者消耗了不成比例的医疗保健支出，但往往得到的是零碎的、次优的护理。自 2003 年以来，总部位于威斯康星州的冈德森健康中心通过综合护理协调计划，改善了具有复杂健康状况的患者的生活质量，并降低了他们的成本负担。这些结果与医疗保险和医疗补助服务中心资助的最成功的护理协调示范项目的数据一致。具体而言，冈德森的计划与减少住院时间、降低住院病人的成本、减少住院服务的使用以及提高患者满意度有关。冈德森的成功源于其以团队为基础的协调护理方法。团队由经过专科培训的护士领导，在住院和门诊环境中定期与患者及其医生进行面对面的接触；让患者深入参与护理相关决策；访问一个跟踪患者护理情况的全系统电子病历数据库；并从宏观层面上考虑护理相关因素和成本。对于那些有兴趣进行协调护理的机构来说，冈德森的模式提供了具体的经验教训，因为它们正在设计旨在提高质量和降低成本的项目。本机构案例研究提供了一个窗口，可以了解在医疗保健提供和报销机制即将发生重大变化的时代，大型医疗保健系统中执行良好的协调护理情况。
