Division of Ambulatory Medicine, Department of Medicine.
Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Medicine (Baltimore). 2021 Feb 5;100(5):e23928. doi: 10.1097/MD.0000000000023928.
Care maps (CMs), which are innovative, comprehensive, educational, and simple medical tools, were developed for 6 common diseases, including heart failure, stroke, hyperglycemia, urinary tract infection, dengue infection, and upper gastrointestinal bleeding, were implemented in a short-stay ambulatory ward. This study aimed to investigate the effectiveness of and level of clinician satisfaction with CMs in an ambulatory care setting.A retrospective chart review study comparing the quality of care between before and after CM implementation was conducted. The medical records of patients who were admitted to a short-stay ambulatory ward in a tertiary referral center were reviewed. Demographic data, severity of disease, quality of care, length of stay (LOS), admission cost, and CM user satisfaction were collected and recorded.The medical records of 1116 patients were evaluated. Of those, 589 and 527 patients were from before (non-CM group) and after CM (CM group) implementation, respectively. There were no significant differences between groups for age, gender, or disease-specific severity the median (interquartile range) total and essential quality scores were significantly higher in the CM group than in the non-CM group [total quality score 85.3 (75.0-92.9) vs 61.1 (50.0-75.0); P < .001, and essential quality scores 90.0 (75.0-100.0) vs 60.0 (40.6-80.0); P < .0001, respectively]. All aspects of quality of care were significantly improved between before and after CM implementation. Overall median LOS was significantly decreased from 3.8 (2.5-5.7) to 3.0 (2.0-4.9) days, but there was no significant decrease for admission cost. However, CMs were able to significantly reduce both LOS and admission cost in the infectious disease-related subgroup. Most CM users reported satisfaction with CMs.CMs were shown to be an effective tool for improving the quality of care in patients with ambulatory infectious diseases. In that patient subgroup, LOS and admission cost were both significantly reduced compared to pre-CM implementation.
护理图(CM)是一种创新、全面、具有教育意义且简单的医疗工具,针对 6 种常见疾病(心力衰竭、中风、高血糖、尿路感染、登革热感染和上消化道出血)进行了开发,并在短期住院门诊病房中实施。本研究旨在调查 CM 在门诊护理环境中的有效性和临床医生满意度水平。
本研究进行了一项回顾性图表审查研究,比较了 CM 实施前后护理质量的差异。对一家三级转诊中心短期住院门诊病房的患者病历进行了回顾。收集并记录了人口统计学数据、疾病严重程度、护理质量、住院时间(LOS)、入院费用和 CM 用户满意度。
评估了 1116 名患者的病历。其中,589 名和 527 名患者分别来自 CM 实施前(非 CM 组)和实施后(CM 组)。两组在年龄、性别或疾病特定严重程度方面无显著差异,但 CM 组的总质量评分和基本质量评分中位数(四分位距)均显著高于非 CM 组[总质量评分 85.3(75.0-92.9)比 61.1(50.0-75.0);P<0.001,基本质量评分 90.0(75.0-100.0)比 60.0(40.6-80.0);P<0.0001]。CM 实施前后,所有方面的护理质量均显著提高。总体 LOS 中位数从 3.8(2.5-5.7)天显著降至 3.0(2.0-4.9)天,但入院费用无显著降低。然而,CM 能够显著降低传染病相关亚组的 LOS 和入院费用。大多数 CM 用户报告对 CM 满意。
CM 被证明是提高门诊传染病患者护理质量的有效工具。在该患者亚组中,与 CM 实施前相比,LOS 和入院费用均显著降低。