A pilot study of the implementation of a multi-disciplinary approach to the episodic health care m nagement of adult acute core medicine inpatients

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Jabusch, Kimberly M.
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In response to changes within a reformed health care system, nursing initiatives have been sought to redesign the delivery structure of inpatient care services to improve the organization and integration of episodic health care management. One such solution has been the development and implementation of the Care Co-ordinator Model (CCM) on two adult medicine, clinical teaching units within an urban tertiary care facility. A quasi-experimental study design was used to compare the outcomes of the CCM on two experimental units with a Total Patient Care nursing system. One-hundred and nineteen subjects were recruited. Structured questionnaires, archival records and an interview schedule collected data on the following dependent study variables: patient and staff satisfaction, patient post-discharge rates of health care service utilization, and total unit operating expenditures. Results of the study found no significant differences between the two nursing organizational systems in reported patient satisfaction or in patient rates of post-discharge health care service utilization from pre- to posttest. A significant increase in reported satisfaction with job autonomy from baseline to posttest was found for staff nurses on one of the two experimental units $(p < .02).$ However, all three groups of nurses reported a significant decline in satisfaction with job worth over time $(p < .02).$ Interdisciplinary staff on one of the two experimental units reported a significant increase in satisfaction with the quality of nursing care from pre- to posttest $(p < .05).$ Finally, study analysis found that total unit operating expenditures on the two experimental units increased by more than 26% during the budget year following implementation of the CCM than in comparison with 1997 cost figures. (Abstract shortened by UMI.)