ABSTRACT
At NEMC, critical pathway development started in areas in which we sought managed care contracts. Critical pathways are now developed by specific clinical services as they analyze their high-volume or high-cost case types. Our initial efforts have demonstrated the value of intervention by pharmacists in the analysis of the drug therapy aspects of pathways. To date, our critical pathway development has been focused on inpatient treatment and includes disease treatment methods as well as costs. In time, our PPI-guided development of critical pathways should reflect comprehensive treatment of patients with acute as well as nonacute disease. In this context, educating patients about their disease and drug therapy and monitoring compliance and overall drug treatment are vital to the successful implementation of critical pathways used in a capitated payment environment.
Subject(s)
Academic Medical Centers/organization & administration , Managed Care Programs/organization & administration , Boston , Clinical Protocols , Drug Therapy , Hospital-Physician Joint Ventures , Humans , Length of Stay , Patient Care Planning , Pharmacy Service, Hospital , Program DevelopmentABSTRACT
Health-status measurement is discussed, and a paradigm for the management of patient outcomes is described and applied to a patient case. Challenged not only to eradicate disease but to improve health, today's health-care professionals must examine the structure, process, and outcomes of care to ensure that optimal care is provided. Techniques for measuring outcomes have been developed; important indicators are functional status, general well-being, and the patient's assessment of care. An interdisciplinary team of physicians, social scientists, and public policy experts at The Health Institute, New England Medical Center, Boston, Massachusetts, studies ways of monitoring and improving the quality and efficiency of care. The team, which now includes a pharmacist, is working to develop practical systems of care whose outcomes can be tested in patients at the medical center. The paradigm developed for the management of patient outcomes begins with evaluation based on results of history, physical examination, and diagnostic tests. Problems and goals (therapeutic endpoints) are then defined, and the safest, most effective, and least costly treatment is selected. Treatment is monitored for subjective and objective results and adjusted as necessary. The achievement of each endpoint contributes to improvement of the patient's health. Knowledge of health-status measurement will enable pharmacists to increase their contribution to patients' health.
Subject(s)
Outcome and Process Assessment, Health Care/methods , Pharmacy Service, Hospital/standards , Aged , Algorithms , Health Services Research , Health Status Indicators , Humans , Male , Models, Theoretical , New England , Patient Care Team , PharmacistsABSTRACT
Struvite calculi result from urinary tract infections secondary to urease-producing bacteria. To prevent recurrent infection and stone formation complete removal of struvite calculi is recommended. Two illustrative reports of patients with renal struvite calculi are presented in which 10% hemiacidrin (Renacidin) irrigation was instituted for stone dissolution. After surgical removal of the calculi a nephrostomy tube was placed in the renal pelvis. With confirmation of residual struvite calculi, 10% hemiacidrin irrigation was initiated. Urine cultures, electrolytes and nephrotomograms were performed and adverse effects monitored. Using strict aseptic technique and appropriate precautions, hemiacidrin irrigation safely dissolves struvite calculi.
