Mark E. Schario, MS, RN, FACHE, is the vice president, Population Health and President, University Hospitals (UH) Quality Care Network, UH Accountable Care Organization & UH Coordinated Care Organization. He leads the Population Health services for UH of Cleveland. Before joining UH, he has led clinical integration networks and accountable care, served as a vice president of operations/chief nurse executive, and senior field director for The Joint Commission. He is a retired lieutenant colonel with the U.S. Army.
Carol A. Bahner, BSN, RN, CCM, is the manager of care management in Population Health at University Hospitals (UH). Her 25+ years of nursing career at UH spans pediatric bedside nursing, home health care coordination, and care management in UH's Accountable Care Organization from its inception. She is passionate about helping people with chronic disease optimize their health.
Prof Case Manag. 2022;27(1):19-25. doi: 10.1097/NCM.0000000000000504.
PURPOSE/OBJECTIVES: Chatbots are automated conversation pathways that users can access through text message or email on smartphones or other connected devices. In care management, they can be used to monitor patients' health conditions or recovery from procedures. This article describes nurse care managers' experiences using chatbots in patient care, illustrated through two patient case reviews. Considerations for planning and implementing chatbot technology in care management settings are discussed.
This care management service is part of an accountable care organization that serves 582,000 patients in University Hospitals of Cleveland, Ohio. Care management focuses on patients with chronic conditions, recent hospital discharges, and other needs. Care managers comprise a centralized team as well as embedded staff in select primary care practices.
FINDINGS/CONCLUSIONS: The two patient cases are exemplars from the care management program serving patients recently discharged from the hospital with ongoing chronic conditions that increase risk for readmission. Use of chatbots helped overcome obstacles to conventional care management outreach and resulted in improved outcomes and strong trusting relationships with the care managers.
Patients who typically do not respond to other types of care manager outreach may respond to text message-based, asynchronous chatbot communication. Interpersonal relationships between care managers and patients can be strengthened by chatbot support. Chatbot technology tracks patients' progress and offers insights to patients and clinicians to facilitate earlier interventions when problems occur. Chatbots make frequent patient contact to collect and provide routine information, allowing care managers to spend more time on high-value interactions that require clinical judgment. Potential concerns about chatbots include effect on labor force, information security, health equity, and oversight of content.
目的/目标：聊天机器人是用户可以通过智能手机或其他连接设备上的短信或电子邮件访问的自动化对话途径。在护理管理中，它们可用于监测患者的健康状况或从手术中恢复的情况。本文通过两个患者案例回顾，介绍了护士护理经理在患者护理中使用聊天机器人的经验。讨论了在护理管理环境中规划和实施聊天机器人技术的注意事项。
该护理管理服务是俄亥俄州克利夫兰大学医院的一个责任制医疗组织的一部分，为 582000 名患者提供服务。护理管理重点关注患有慢性病、最近出院和其他需求的患者。护理经理由一个集中团队以及在选定的初级保健实践中嵌入的工作人员组成。
发现/结论：这两个患者案例是护理管理计划的代表案例，该计划为最近从医院出院且患有增加再入院风险的持续慢性病的患者提供服务。使用聊天机器人有助于克服传统护理管理外展的障碍，并导致改善的结果和与护理经理之间的牢固信任关系。
通常不会对其他类型的护理经理外展做出回应的患者可能会对基于短信的异步聊天机器人通信做出回应。聊天机器人支持可以加强护理经理和患者之间的人际关系。聊天机器人技术可以跟踪患者的进展，并为患者和临床医生提供见解，以便在出现问题时尽早进行干预。聊天机器人频繁与患者联系以收集和提供常规信息，从而使护理经理能够将更多时间用于需要临床判断的高价值互动。聊天机器人的潜在问题包括对劳动力、信息安全、健康公平和内容监督的影响。
