ABSTRACT
This article demonstrates effects on utilization of a clinical transformation: changing locus of care from a dedicated sickle cell day unit to an approach that "fast-tracks" patients through the emergency department (ED) into an observation unit with 24/7 access. Retrospective quantitative analyses of claims and Epic electronic medical record data for patients with sickle cell disease treated at Thomas Jefferson University (inpatient and ED) assessed effects of the clinical transformation. Additionally, case studies were conducted to confirm and deepen the quantitative analyses. This study was approved by the Thomas Jefferson University Institutional Review Board. The quantitative analyses show significant decreases in ED and inpatient utilization following the transformation. These effects likely were facilitated by increased observation stays. This study demonstrated the impact on utilization of transformation in care (from dedicated day unit to an approach that fast-tracks patients into an observation unit). Additional case studies support the quantitative findings.
Subject(s)
Academic Medical Centers/organization & administration , Anemia, Sickle Cell/therapy , Emergency Service, Hospital/statistics & numerical data , Patient Care Team/organization & administration , Quality Improvement/organization & administration , Health Services Accessibility/organization & administration , Hospitals, Urban/organization & administration , Humans , Insurance Claim Review/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Retrospective Studies , Social WorkersABSTRACT
Resumen: PAIN OUT es un sistema de gestión en calidad que consiste en un registro internacional (http://.www.pain-out.eu), y tiene la finalidad de realizar auditorías internas que permiten la evaluación y la optimización del tratamiento de pacientes con dolor postoperatorio. En 2016, se inició un proyecto internacional, donde 10 hospitales de la Ciudad de México participaron para mejorar la calidad en la atención del dolor postoperatorio, los cuales fueron coordinados por la Universidad de Jena, Alemania y el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (para más detalles visite http://www.painoutmexico.com).
Abstract: PAIN OUT is a quality management system that consists of an international register (http://.www.pain-out.eu), which aims to perform internal audits that allow the evaluation and optimization of the treatment of patients with postoperative pain. In 2016 an international project was initiated where 10 hospitals in Mexico City participated to improve the quality of postoperative pain care, coordinated by the University of Jena, Germany and the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (for more details visit http://www.painoutmexico.com).
ABSTRACT
Sickle cell disease (SCD), an inherited red blood cell disorder, is characterized by anemia, end-organ damage, unpredictable episodes of pain, and early mortality. Emergency department (ED) visits and hospitalizations are frequent, leading to increased burden on patients and increased health care costs. This study assessed the effects of a multidisciplinary care team intervention on acute care utilization among adults with SCD. The multidisciplinary care team intervention included monthly team meetings and development of individualized care plans. Individualized care plans included targeted pain management plans for management of uncomplicated pain crisis. Following implementation of the multidisciplinary care team intervention, a significant decrease in ED utilization was identified among those individuals with a history of high ED utilization. Findings highlight the potential strength of multidisciplinary interventions and suggest that targeting interventions toward high-utilizing subpopulations may offer the greatest impact.