McCormick W C, Inui T S, Deyo R A, Wood R W
J Case Manag. 1994 Summer;3(2):56-61, 87.
Case managers can play a pivotal role in the hospital discharge planning process for medically complex patients. This is particularly true for persons with AIDS. This prospective study quantifies the importance of this role by examining the ability of case managers, nurses, and physicians to predict (at the time of admission) whether hospitalized AIDS patients would be appropriate for transfer to long-term care facilities after their hospital stays. We studied 120 AIDS patients and their primary providers; 38 (32%) patients were found to be appropriate for discharge to long-term care facilities at the end of their hospital stays. Physicians and nurses had similar accuracy in predicting eventual appropriateness for long-term care (75% and 73% correct, respectively); however, case managers were far more accurate than the physicians and nurses (93% correct, p < .05). This finding highlights the unique ability of case managers to facilitate discharge planning early on in the hospital stays of these complex patients. In this study, case managers were more accurate than physicians or nurses in predicting appropriateness for long-term care of hospitalized persons with AIDS. Case managers should play an integral role in coordinating discharge planning of persons with AIDS; this planning should be part of the hospital admission process.
病例管理人员在为病情复杂的患者制定出院计划的过程中可发挥关键作用。对于艾滋病患者而言尤其如此。这项前瞻性研究通过考察病例管理人员、护士和医生（在入院时）预测住院的艾滋病患者在住院后是否适合转至长期护理机构的能力，对这一角色的重要性进行了量化。我们研究了120名艾滋病患者及其主要医护人员；在住院结束时，发现38名（32%）患者适合出院至长期护理机构。医生和护士在预测最终是否适合长期护理方面的准确率相近（分别为75%和73%正确）；然而，病例管理人员的准确率远高于医生和护士（93%正确，p < .05）。这一发现凸显了病例管理人员在这些病情复杂的患者住院早期阶段推动出院计划制定的独特能力。在本研究中，病例管理人员在预测住院艾滋病患者是否适合长期护理方面比医生或护士更准确。病例管理人员应在协调艾滋病患者的出院计划中发挥不可或缺的作用；该计划应成为医院入院流程的一部分。
