医疗协调项目中的资源利用监测

Monitoring Resource Utilization in a Health Care Coordination Program.

作者信息

Popejoy Lori L, Jaddoo Julie, Sherman Jan, Howk Christopher, Nguyen Raymond, Parker Jerry C

机构信息

Lori L. Popejoy, PhD, APRN, GCNS-BC, is an Associate Professor in the Sinclair School of Nursing, University of Missouri, Columbia. She is Co-Director and co-investigator for the Leveraging Information Technology to Guide High-Touch, High-Tech (LIGHT2) care project. Dr. Popejoy's area of research and practice is care coordination for older adults. Julie Jaddoo, BSc, CIS, is a Health Information Analyst with the LIGHT2 project. She started working with the project in May 2014. She will be completing a Master in Health Informatics in May 2015. She is a Health Information Analyst for the LIGHT2 project described in this paper. Jan Sherman, PhD, APRN, NNP-BC, is an Associate Teaching Professor in the Sinclair School of Nursing, University of Missouri, Columbia. She was the Coordinator for Curriculum Development and Training for the LIGHT2 project described in this paper. Dr. Sherman's area of research and practice is the neonatal population. Christopher Howk, BA, is a consultant at Cerner Corporation working with the Tiger Institute in Columbia, Missouri to deliver the High-Tech components of the LIGHT2 project described in the paper. His main focus on the project was on technical reporting and quality improvement. Raymond Nguyen, MS, is a graduate student in the Department of Mathematics at the University of Missouri, Columbia where he is currently pursuing a PhD. He was a Health Information Analyst for the LIGHT2 project described in this paper. Jerry C. Parker, PhD, is the Associate Dean for Research and Co-Director of the MU Institute for Clinical and Translational Science at the University of Missouri School of Medicine. He is the Principal Investigator and Director of LIGHT2.

出版信息

Prof Case Manag. 2015 Nov-Dec;20(6):310-20. doi: 10.1097/NCM.0000000000000120.

DOI:10.1097/NCM.0000000000000120

PMID:26437137

Abstract

PURPOSE OF THE STUDY

This initial article describes the development of a health care coordination intervention and documentation system designed using the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Atlas framework for Centers for Medicare & Medicaid-funded innovation project, Leveraging Information Technology to Guide High-Tech, High-Touch Care (LIGHT).

PRIMARY PRACTICE SETTING(S): The study occurred at an academic medical center that serves 114 counties. Twenty-five registered nurse care managers (NCMs) were hired to work with 137 providers in 10 family community and internal medicine clinics.

METHODOLOGY AND SAMPLE

Patients were allocated into one of the four tiers on the basis of their chronic medical conditions and health care utilization. Using a documentation system on the basis of the AHRQ domains developed for this study, time and touch data were calculated for 8,593 Medicare, Medicaid, or dual-eligible patients.

RESULTS

We discovered through the touch and time analysis that the majority of health care coordination activity occurred in the AHRQ domains of communication, assess needs and goals, and facilitate transitions, accounting for 79% of the NCM time and 61% of the touches. As expected, increasing tier levels resulted in increased use of NCM resources. Tier 3 accounted for roughly 16% of the patients and received 159 minutes/member (33% of total minutes), and Tier 4 accounted for 4% of patients and received 316 minutes/member (17% of all minutes). In contrast Tier 2, which did not require routine touches per protocol, had 5,507 patients (64%), and those patients received 5,246 hours of health care coordination, or 57 minutes/member, and took 48% of NCM time.

IMPLICATIONS FOR CASE MANAGEMENT

The AHRQ Care Coordination Atlas offered a systematic way to build a documentation system that allowed for the extraction of data that was used to calculate the amount of time and the number of touches that NCMs delivered per member. 2. Using a framework to systematically guide the work of health care coordination helped NCMs to think strategically about the care being delivered, and has implications for improving coordination of care. 3. For the purpose of reimbursement and communication with payers about quality metrics, it is vital that the type of touches and amount of time spent in delivering care coordination be documented in a manner that can be easily retrieved to guide practice decisions.

摘要

研究目的

这篇初始文章描述了一种医疗保健协调干预措施和文档系统的开发，该系统是利用医疗保健研究与质量局（AHRQ）的医疗协调地图集框架为医疗保险和医疗补助创新项目“利用信息技术引导高科技、高接触式护理（LIGHT）”设计的。

主要实践场所

该研究在一家服务114个县的学术医疗中心进行。雇佣了25名注册护士护理经理（NCM）与10个家庭社区和内科诊所的137名医疗服务提供者合作。

方法与样本

根据患者的慢性疾病状况和医疗保健利用率，将患者分为四个层级之一。使用基于为本研究开发的AHRQ领域的文档系统，计算了8593名医疗保险、医疗补助或双重资格患者的时间和接触数据。

结果

通过接触和时间分析，我们发现大多数医疗保健协调活动发生在AHRQ的沟通、评估需求和目标以及促进转诊等领域，占NCM时间的79%和接触次数的61%。正如预期的那样，层级越高，NCM资源的使用就越多。三级占患者总数的约16%，每位成员接受159分钟（占总分钟数的33%），四级占患者的4%，每位成员接受316分钟（占所有分钟数的17%）。相比之下，根据方案不需要常规接触的二级有5507名患者（64%），这些患者接受了5246小时的医疗保健协调，即每位成员57分钟，占NCM时间的48%。

对病例管理的启示

AHRQ医疗协调地图集提供了一种系统的方法来构建文档系统，该系统允许提取用于计算NCM为每位成员提供的时间量和接触次数的数据。2. 使用一个框架来系统地指导医疗保健协调工作有助于NCM从战略角度思考所提供的护理，并对改善护理协调有启示作用。3. 为了报销以及与支付方就质量指标进行沟通，至关重要的是，记录提供护理协调时的接触类型和花费的时间量，以便能够轻松检索以指导实践决策。