总结：病案管理是管理涉及多领域的治疗活动、以及按病案的类型和诊断相关的特定医院的病人群体的相应资源的一种工具。它平衡治疗的实施与成本以期为病人达到满意的治疗结果，特别是那些不能按常规的处理流程治疗的病人。来源是面临个方面降低成本的压力。Hospital-BasedCaseManagement:PartIGeorgeByronSmith,RN,MSN,CCMDebraAnnDanforth,RN,BSN--------------------------------------------------------------------------------Thegoalofthisprogramistoexplainhospitalcasemanagementanditsbenefitstoprofessionalnurses.Afteryoustudytheinformationpresentedhere,youwillbeableto—Listthreegoalsofcasemanagementinacutecarehospitals.Identifythreecommoncharacteristicsofaneffectivecasemanagementsystem.Identifytwobenefitsofcasemanagementinhospitals.--------------------------------------------------------------------------------LeonardBoydisadmitteddirectlyfromtheemergencydepartmenttoacriticalcareunitwithadiagnosisofcongestiveheartfailure(CHF).HisnurseimmediatelyinitiatestheCHFclinicalpathwayandduringthefirsttwodaysheprogressesasexpected.However,Mr.Boyddevelopsunanticipatedcomplicationsonthethirdday.Thenursecallsthecasemanager(CM),whoconvenesameetingwiththemultidisciplinarycareteam.Theteamdiscussesthepatient’scurrentstatusandexpectedoutcomes,anddevelopsarevisedplanofcaretodealwiththispatient’sspecificdeviationsfromtheusualcourseofevents.Duringtherestofthehospitalization,theCMwillevaluateMr.Boyd’sprogressionontheclinicalpathwayandwilldocumentanyvariancefromexpectedpatientoutcomes.TheCMwillalsoworkwiththeteamtoensurethattheirinterventionsbothmaintainqualityandmaximizetheuseofresourcesinhiscare.（案例）Hospital-basedcasemanagementisatoolformanagingthemultidisciplinarycareactivitiesandresourcesforspecifichospitalpatientpopulationsclassifiedbycase-typeand/ordiagnostic-relatedgroup(DRG).Itbalancesthedeliveryandcostsofcaretoachievedesirableoutcomesforpatients,forthosepatientswhoare“predictable,”butespeciallyforthosewhomightnotfollowausualcourseofeventsduringtheirhospitalization.ThisinnovationisaresponsetopressuresbyMedicare,insurancecompanies,andmanagedcarecompaniesonbehalfofself-insuredemployerstoreducethecostofcare.Careisreimbursedbyall-inclusive,globalpayments,suchasbyDRGs,capitation(wherethehospitalorhealthcareorganizationispaidapersubscriber,permonthfeetocoverallhealthcareexpenditures,nomatterwhatthecostofcare),orstringentper-diemrates.Theinsurancecompaniesdenyreimbursementforhospitaldaysusedinexcessoftheexpectednorm.Theexpectednormhassteadilydecreasedoverthepastfiveyears.Sickerhospitalpatients,whorequiremorelaborintensivenursingcareandmoreexpensivetests,treatments,andotherhospitalservices,havecreatedademandforbettersystemstomanagefiniteresources.Thishaspushedhospitalstoimplementinnovativesystemstoenhancebothqualityandcost-effectiveness.Thechallengeofplacingpatientsintheappropriatelevelofcarealsoexistswithanincreaseincomplexityofpatients.Inhospitals,nursingcareisoftenmanagedbyaunit-baseddeliverysystemthatisorganizedtoachievespecificpatientoutcomeswithincost-effectivetimeframeswiththeappropriateresources.Thiscaresystemisstructuredbycasemanagementandclinicalpathwaysorsimilarprotocolsthatoutline“bestpractice”careforsubsetsofpatients.Whenapatient’sprogressdeviatesfromtheexpectedcourse,acasemanagerandamultidisciplinaryteamconvergetoredirectthecourseofcare.Casemanagementhasflourishedbecauseitaddressestherequirementso...
