The continued growth of managed care organizations and capitated reimbursement of inpatient care have increased pressures on hospitals to reduce length of stay, reduce readmission rates, and decrease costs while maintaining quality of care to enhance health related quality of life and patient satisfaction. Primary specific aims are to compare the effectiveness of care management by a hospitalist MD/acute care nurse practitioner multidisciplinary care management team versus conventional approach to care delivery for acutely ill general medicine inpatients on organizational and patient outcomes at admission, hospital discharge, one month post discharge, and 6 months post discharge. Patient outcome variables are patient satisfaction and health related quality of life. Organizational outcome variables are length of stay, cost, readmission rate, and resource utilization. Secondary specific aims are to describe the relationship of physician/nurse communication/collaboration to the respective outcome variables. The design is a prospective, quasi-experimental, pretest, post test study. The study population is 1200 hospitalized, acutely ill, general medicine patients, 600 in each group. The study setting is an academic medical center with 610 beds and approximately 25,000 admissions per year. Attending physician faculty, residents, and interns, respectively, will be randomized to the experimental or control arms and will admit patients (after informed consent) depending upon which consecutively scheduled team is on duty to take admissions. The multidisciplinary team care management will include the following components: collaborative inpatient clinical responsibilities and coverage, case managements communication, practice guideline development, quality assurance review of resource utilization and clinical outcomes, and 30 day comprehensive discharge care. The organizational outcome variables will be obtained from the hospital computer database. Patient satisfaction will be measured by Picker hospital survey. Health related quality of life will be assessed by the SF-12, Health Utilities Index Mark 3, and Dartmouth Cooperative Information Project COOP charts for health related quality of life variables. Statistical analyses will include univariate tests (t, z, and Chi- square), Cox proportional hazards model, logistic regression, Poisson, and linear regressions.
| Vazirani, Sondra; Hays, Ron D; Shapiro, Martin F et al. (2005) Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care 14:71-7 |
