Hospital Based Managed Care: Cost and Quality. Executive Summary

摘要

The objective of the research project was to determine the effects of Hospital Based Managed Care (HBMC) on the cost and quality of hospital care. HBMC is a delivery of care method that involved creating locally derived, multidisciplinary practice guidelines and identifying key markers of patient outcomes. Both the guidelines ('critical path') and the outcome markers were placed on a timeline and patient care followed the content and timing as described. Variances in care and outcomes were documented. A quasi-experimental, before-after design was used. All women who delivered by cesarean section during the 18 months of the study and were cared for in the maternity unit at the University of Iowa Hospitals and Clinics were included in the analysis of cost and length of stay (N=381). Of these, 207 completed questionnaires and interviews regarding quality of care during hospitalization, and 172 were reached for a post-discharge interview. The major findings were: Length of stay after surgery decreased 13.5%; Cost for care after surgery decreased 13.1%; Patient reports of quality of care increased; Patient reports of physical recovery did not change.