Van Etten P
Am J Hosp Pharm. 1985 Oct;42(10):2153-8.
The approach of the New England Medical Center toward case management and increased productivity, and the role of the pharmacy within this system, are described by a chief hospital administrator. External pressures that caused the hospital to alter its management style included changes in reimbursement, hospital overuse, increased competition, and a surplus of physicians. Variations in medical practice that affected admission rates, length of stay, and use of ancillary services existed because clinical and financial data had not been integrated, so clinicians had no information on the economic consequences of their decisions. The solution offered to this problem was to decentralize resource-use decisions to increase clinician accountability. The goal of the case-management system is to reduce the cost of intermediate product (e.g., laboratory tests) use through increased productivity. The system provides pharmacy with a new power base if pharmacists can reduce overall costs by influencing prescribers to use cost-effective therapies. Pharmacy can increase its influence within the institution by forming new relationships with administrators, physicians, and nurses that broaden its impact on cost.
一位医院行政主管描述了新英格兰医疗中心在病例管理和提高生产率方面所采取的方法，以及药房在该系统中的作用。导致医院改变其管理方式的外部压力包括报销政策的变化、医院过度使用、竞争加剧以及医生过剩。由于临床和财务数据没有整合，存在影响住院率、住院时间和辅助服务使用的医疗实践差异，因此临床医生对其决策的经济后果一无所知。针对这个问题提出的解决方案是将资源使用决策分散，以提高临床医生的责任感。病例管理系统的目标是通过提高生产率来降低中间产品（如实验室检查）的使用成本。如果药剂师能够通过影响开处方者使用具有成本效益的疗法来降低总体成本，该系统将为药房提供一个新的权力基础。药房可以通过与管理人员、医生和护士建立新的关系来扩大其在机构内的影响力，从而扩大其对成本的影响。
