Managed care, used for many years to increase efficiency in primary health services, is proposed as a way of increasing efficiency in hospital care. This Hospital Based Managed Care (HBMC) intervention is designed to increase efficiency by eliminating redundant patient care components while maintaining effectiveness of care and patient satisfaction with care. The HBMC intervention consists of a multi- disciplinary CareMap(tm) that includes key care components and patient problems common to a specific group of patients, i.e. diagnostic group, and a Nurse Case Manager. The Nurse Case Manager coordinates a multi- disciplinary team that develops the CareMap(tm), supervises the implementation of the map, provides staff education, and monitors patient progress. This research project is a pilot test of HBMC with C-section patients, preparatory to implementing and testing HBMC throughout the institution. The population used for the pilot test will be all patients with C-section, the most commonly performed surgery in the US. A cohort study, with quasi-comparable groups (N=200), will be used to determine the effects of the intervention on the length of stay, costs, patient outcomes, and satisfaction. HBMC will be implemented on July 1, 1992, and two months will be allowed for all staff to alter their practice to conform with the map. The groups that will be compared are a control group, patients having C-sections from January, 1992, through June, 1992; and an experimental group, patients having C-section from September, 1992 through March, 1993. The procedures for training nurse case managers, developing and implementing CareMaps(tm), and assessing the variance from the map will also be evaluated.
