Curley C, McEachern J E, Speroff T
School of Medicine, Case Western Reserve University, MetroHealth Medicl Center, Cleveland, OH 44109, USA.
Med Care. 1998 Aug;36(8 Suppl):AS4-12. doi: 10.1097/00005650-199808001-00002.
In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards. Using standard continuous quality improvement (CQI) methods, a team of medical interns, nurses, and other health professionals involved in patient care on the medicine inpatient service designed interdisciplinary, daily work rounds to improve the care of patients on the inpatient wards.
The authors conducted a randomized, controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services. The trial lasted 6 months (November 1993-April 1994) and included 1,102 admissions randomly assigned to experimental or control teams by the pre-existing firm system. Of the 1,102 admissions included in the study, 535 were randomized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds. The outcomes studied included length of stay (LOS), total hospital charges, provider satisfaction, and ancillary service efficiency.
Unadjusted analysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group. The mean LOS for interdisciplinary rounds was 5.46 days, compared with 6.06 days for traditional care (P = 0.006), whereas mean total charges were $6,681 and $8,090 (P = 0.002) for the two groups, respectively. After multivariate regression analysis using a propensity score that included gender, age, marital status, admission source, diagnosis-related group (DRG) weight, and primary diagnosis by International Classification of Diseases, Ninth Revision (ICD-9) cluster, these differences remained statistically significant.
Previous studies of interdisciplinary teams have failed to show statistically significant cost savings. This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams. At the end of the 6-month trial, interdisciplinary rounds were instituted on all medicine inpatient services.
1993年8月，地铁健康医疗中心的一组住院医师和护理人员组建了一个质量改进团队，以评估住院病房的医疗护理过程。参与内科住院服务患者护理工作的一组实习医生、护士和其他卫生专业人员，运用标准的持续质量改进（CQI）方法，设计了跨学科的每日查房流程，以改善住院病房患者的护理。
作者对跨学科查房对内科住院服务的影响进行了一项随机对照的实境试验。该试验持续了6个月（1993年11月至1994年4月），纳入了1102例入院患者，这些患者通过现有的实境系统随机分配到试验组或对照组。在纳入研究的1102例入院患者中，535例被随机分配到采用传统查房的医疗服务组，567例被随机分配到采用跨学科查房的医疗服务组。所研究的结果包括住院时间（LOS）、总住院费用、医疗服务提供者满意度和辅助服务效率。
对经对数转换的数据进行的未调整分析显示，跨学科组的住院时间和总费用较低。跨学科查房的平均住院时间为5.46天，而传统护理组为6.06天（P = 0.006），两组的平均总费用分别为6681美元和8090美元（P = 0.002）。在使用倾向得分进行多变量回归分析后，这些差异仍然具有统计学意义。倾向得分包括性别、年龄、婚姻状况、入院来源、诊断相关组（DRG）权重以及国际疾病分类第九版（ICD - 9）聚类的主要诊断。
先前关于跨学科团队的研究未能显示出具有统计学意义的成本节约。这项涉及更多患者的研究表明，使用跨学科团队可降低成本和缩短住院时间。在为期6个月的试验结束时，所有内科住院服务都采用了跨学科查房。
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