为成瘾医学咨询服务制定商业案例：定性分析。
Making the business case for an addiction medicine consult service: a qualitative analysis.
机构信息
School of Medicine, MD/PhD Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L357, Portland, OR, 97239, USA.
School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA.
出版信息
BMC Health Serv Res. 2019 Nov 8;19(1):822. doi: 10.1186/s12913-019-4670-4.
BACKGROUND
As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services.
METHODS
Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with OUD. Using a directed content analysis, the transcribed interviews were coded, analyzed, and final themes consolidated.
RESULTS
Semi-structured interviews completed with addiction medicine physicians from established (n = 9) and developing (n = 5) AMC services at 14 U.S. hospitals explored how clinical champions persuaded hospital administrators to support AMC service development. Four elements were foundational to making the "business case": 1) describing the prevalence of substance use disorder (SUD) or OUD in the hospital; 2) identifying the negative financial impacts of not treating SUDs during hospitalization; 3) highlighting the ongoing care quality and treatment gap for hospitalized patients with SUDs; and 4) noting the success of other institutional AMC services. Study findings informed the creation of tools to support AMC service development: 1) an AMC service business case template, and 2) an AMC service design and operations resource list.
CONCLUSIONS
OUD-related hospital admissions are unlikely to abate. Hospital administrators should consider innovative care delivery mechanisms to improve care for persons with OUD. AMC services may be a promising delivery mechanism to achieve this aim. For clinical and administrative champions, understanding how to communicate the potential effectiveness of this intervention to hospital leaders is an essential first step to AMC service creation.
背景
随着北美地区药物中毒危机的恶化和阿片类药物使用障碍（OUD）相关的住院人数增加，政策制定者和医院管理人员开始认识到医院在 OUD 护理连续体中的重要作用。本研究探讨并描述了美国成瘾医学医师如何向医院管理人员提出并呈现商业方案，以支持成瘾医学咨询（AMC）服务的发展。
方法
对来自 14 家美国医院的 15 名经过董事会认证或有资格获得董事会认证的成瘾医学医师进行了 15 次定性访谈。这些访谈是对一项更广泛的混合方法研究的一部分，该研究探讨了为患有 OUD 的住院患者提供医院服务的情况。使用定向内容分析，对转录的访谈进行编码、分析和整合最终主题。
结果
对来自 14 家美国医院的已建立（n=9）和正在发展（n=5）AMC 服务的成瘾医学医师进行的半结构式访谈，探讨了临床专家如何说服医院管理人员支持 AMC 服务的发展。有四个要素是提出“商业案例”的基础：1）描述医院中物质使用障碍（SUD）或 OUD 的流行程度；2）确定在住院期间不治疗 SUD 的负面财务影响；3）突出患有 SUD 的住院患者持续的护理质量和治疗差距；4）注意其他机构 AMC 服务的成功。研究结果为支持 AMC 服务的发展提供了工具：1）AMC 服务商业案例模板；2）AMC 服务设计和运营资源清单。
结论
与 OUD 相关的住院人数不太可能减少。医院管理人员应考虑创新的护理提供机制，以改善 OUD 患者的护理。AMC 服务可能是实现这一目标的有前途的交付机制。对于临床和行政专家来说，了解如何向医院领导传达这种干预措施的潜在有效性是创建 AMC 服务的关键第一步。
Zotero 插件