摘要:

The evolution of health care financing has had a profound effect on the delivery of health care services. Autonomous, provider-directed care with fee-for-service reimbursement combined with expensive medical technology and an overabundance of providers has led to increasing medical costs. In an effort to reduce spending, payers are responding by demanding that providers regulate clinical and financial outcomes under managed care contracts. These contractual arrangements are administrated by a variety of managed care organizations and are forcing providers to coordinate care along the full continuum. Cardiovascular health and disease management is particularly affected because billions of health care dollars are consumed in this area. This article explores the evolution of the current crisis in health care financing and its effects on providers and payers. Future opportunities for cardiovascular providers in this changing health care environment are briefly discussed.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Issues surrounding health care spending, reform, and future directions have generated much concern and debate among health care providers. Increasingly, cardiovascular nurses are challenged to respond to the health care needs of clients in the 21st century. This article discusses trends in the health care system, including the current emphasis on illness and emerging efforts supporting health promotion. The discussion includes an overview of health care restructuring and the use of care management as a comprehensive strategy for cardiovascular nursing practice to support health promotion across a trajectory of illness and wellness.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Health risk assessment, developed as a clinical tool for the practice of prospective medicine, has been used primarily in worksite health promotion programs to identify cardiac and other risk factors and to plan preventive actions. This article describes the application of a brief health risk assessment with targeted follow-up to a managed care population, randomized by primary care physicians into usual care and special intervention groups. Study design, methods, and preliminary baseline data on participants are presented, and key learnings about administration of this type of program in an integrated health care system are discussed.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Outpatient cardiac centers, diabetic treatment clinics, multi specialty medical groups, and primary care medicine currently have a unique opportunity to establish cost-effective lipid management clinics. Such programs have been shown to reduce progression of coronary vascular disease, reduce mortality and clinical events, and ultimately reduce health care costs. Successful lipid clinic operation requires thorough clinical assessment, comprehensive and aggressive non pharmacologic and pharmacologic therapy, productive compliance strategies, and meaningful outcomes measures. Also required are sound billing procedures, an effective marketing plan, a continual relationship with lipid training organizations, and full integration in the disease management process throughout the continuum of care. This systematic and aggressive approach to lipid management affords a significant opportunity for qualified nurses and allied health professionals to help reduce the unnecessary burden of premature cardiovascular disease.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The dilemma of the high cost of quality health care in a managed care environment for chronic disease populations has led to the development of a nurse-managed chronic care clinic that focuses on outpatient case management of chronic diseases beginning with chronic heart failure patients. The clinic provides advanced practice nurse management for heart failure patients in pharmacotherapy, education, counseling, dietary and lipid management, and exercise training via software management programs. The clinic is developing further management for comorbidity factors such as diabetes and chronic obstructive pulmonary disease. The history, development, and function of the clinic are reviewed.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Managed care was the impetus for a program designed to move adult patients from acute care to the lowest level of appropriate services after cardiac surgery. Clinical pathways and a home care cardiac specialty team were the major components of the Early Discharge Program. The program was evaluated based on both financial and clinical outcomes. A convenience sample of 119 pretest patients was compared with 101 posttest patients 3 months after program implementation. Hospital length of stay decreased only 0.34 days on average, but inpatient direct variable costs decreased by an average of $1,790 per patient. Based on the 101 patients in the posttest group, $180,790 in direct variable hospital costs were saved. The largest decrease in resource use was in those patients who were discharged to home care. Complications and home caregiver burden after discharge were no higher in patients discharged early. Early discharge of cardiac surgery patients appears to be safe and cost-effective.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Managed care has changed the way health care is delivered in the United States. Simultaneously, major changes in the management of patients with coronary heart disease has led to dramatic shifts in cardiac rehabilitation. Exercise training, education, and counseling to modify coronary risk factors has clearly been shown to benefit patients with coronary disease. Moreover, intensive risk factor modification has been shown to prevent progression of coronary atherosclerosis and to lower morbidity and mortality. Newer delivery models of rehabilitation are needed to improve health outcomes in a cost-effective way. A nursing case management model (MULTIFIT), illustrates one such innovative delivery model that meets the needs of a managed care plan for comprehensive cardiovascular risk reduction and surveillance of patients.

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:1996

数据来源: OVID