Planning an integrated population-based program

Developing evidence-based nursing roles: lessons learned from the health care integrator role

PURPOSE

This study examined a unique nursing role in the United States Air Force to determine if it had been well institutionalized and to identify barriers and facilitators during the implementation process.

SOURCE OF INFORMATION

Individuals functioning in the role were surveyed to measure time spent on specific job-related tasks, additional duties, and positive and negative experiences.

CONCLUSIONS

Eighty-seven percent of the respondents (n = 45) indicated that the role had been well implemented, although wide variation existed in tasks performed and major organizational barriers identified. Findings of this study can be used to guide the development of other evidence-based positions.

Shifting the healthcare paradigm: the case manager's opportunity and responsibility

Recent shifts in the healthcare system reflect a shift in thinking from sickness to wellness. This article reviews the paradigm shift, incentive system, and issues related to cost and quality. The role of case management in facilitating this transition is discussed. The article concludes with a discussion of the challenge to use nursing's unique disciplinary perspective that is focused on health to develop new approaches and strategies and the opportunities for case management to expand its scope of practice.

Cultivating a disease management partnership: a value-chain model

Disease management (DM) is one of the health care industry's more innovative value-chain models, whereby multiple relationships are created to bring complex and time-sensitive services to market. The very nature of comprehensive, seamless DM provided through an outsourced arrangement necessitates a level of cooperation, trust, and synergy that may be lacking from more traditional vendor-customer relationships. This discussion highlights the experience of one health plan and its vendor partner and their approach to the development and delivery of an outsourced heart failure (HF) DM program. The program design and rollout are discussed within principles adapted from the theoretical framework of a value-chain model. Within the value-chain model, added value is created by the convergence and synergistic integration of the partners' discrete strengths. Although each partner brings unique attributes to the relationship, those attributes are significantly enhanced by the value-chain model, thus allowing each party to bring the added value of the relationship to their respective customers. This partnership increases innovation, leverages critical capabilities, and improves market responsiveness. Implementing a comprehensive, outsourced DM program is no small task. DM programs incorporate a broad array of services affecting nearly every department in a health plan's organization. When true seamless integration between multiple organizations with multiple stakeholders is the objective, implementation and ongoing operations can become even more complex. To effectively address the complexities presented by an HF DM program, the parties in this case moved beyond a typical purchaser-vendor relationship to one that is more closely akin to a strategic partnership. This discussion highlights the development of this partnership from the perspective of both organizations, as revealed through contracting and implementation activities. It is intended to provide insight into the program development and rollout processes that one health plan and its partner have adopted to advance a DM model that integrates appropriately within the local environment. This discussion also highlights how an organizational culture can shift from an emphasis on cost, growth, and control to an emphasis on quality, innovation, and service within a value-chain model.

Total joint replacement: baseline benchmark data for interdisciplinary outcomes management

PURPOSE

The purpose of this review was to define and describe 2 years of adverse outcome variances for elective primary or revision of major total joint replacement in terms of baseline benchmark data.

DESIGN

Descriptive variance.

METHODS

Retrospective review of patients with greater than 4 days in acute care after total joint replacement, patients with unexpected comorbidities that required medical subspecialist management, patients who were transferred to a higher level of care, and patients who did not survive postoperatively.

FINDINGS

This review indicates that patients treated on a higher volume dedicated orthopaedic unit experience fewer adverse outcomes and shorter length of stay than patients treated on a general surgical unit.

CONCLUSIONS

Patients who are treated on a dedicated orthopaedic unit experience significantly fewer adverse outcomes or outcome variations. Costs can be effectively managed, and optimal clinical patient outcomes can be achieved with few complications. Treatment strategies can be used as a template for enhanced care processes for this population.