PubMed Health⌕ Search

PubMed · 1288610

Implementing managed care in a pediatric setting.

Abstract

A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children's hospital.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

J H Barnsteiner, A Mohan, P Milberger. 1992. Implementing managed care in a pediatric setting.. https://doi.org/10.4037/15597768-1992-4006

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Utilization of pediatric hospitals in New York State.

BACKGROUND: Little published information is available regarding the proportion of hospitals that offer pediatric services at specified levels, or the actual utilization of such services. OBJECTIVE: To determine if an existing national accreditation process created for educational purposes identifies hospitals with a distinct utilization pattern, in a sample of pediatric inpatient activity from one state. METHODS: Hospitals in New York State were classified as "pediatric" hospitals according to their sponsorship or major participation with an accredited pediatric residence program. Institutions not affiliated with pediatric residencies were considered to be the "other" hospitals. Data on hospital discharges and interhospital transfers were studied for children from 0 to 14 years old, excluding neonatal Diagnosis-Related Groups. Data were obtained from the New York Statewide Planning and Research Cooperative System for 1996, 1997, and 2000. RESULTS: Sixteen percent of hospitals were considered to be "pediatric" facilities (42 of 257) by study criteria. Annual pediatric inpatient activity per "pediatric" hospital significantly exceeded that in "other" institutions, including hospitalizations (2249 +/- 1284 vs 258 +/- 348), number of interhospital transfers received (153 +/- 88 vs 18 +/- 26), and number of hospitals referring interhospital transfers to each receiving hospital (36 +/- 17 vs 5 +/- 7; mean +/- standard deviation; for each comparison). Statewide, "pediatric" hospitals served two thirds of all hospitalized children and 70% of all children's hospital days. "Pediatric" hospitals cared for 26.5 patients per hospital day, compared with only 2.2 per day at "other" institutions. Although statewide hospitalizations of children fell by 14.3% the proportion of all pediatric hospitalizations served by "pediatric" hospitals increased by 3.8% from 1996 to 2000. CONCLUSIONS: Although intended for educational purposes, hospital affiliation with an accredited pediatric residency program identifies a subgroup of facilities with a distinct utilization pattern, which provides care for the majority of pediatric inpatients, and serves as a resource to other hospitals.

Hospitals, Pediatric↗

Newer experience with CPAP.

Progress in neonatal intensive care is closely linked to improvements in the management of respiratory failure in small infants. Current modalities of ventilatory assistance range from more benign continuous positive airway pressure (CPAP) to various modes of mechanical ventilation (including high frequency ventilation). The advent of less invasive methods of delivering CPAP has permitted earlier treatment of infants with respiratory distress syndrome and avoided the need for mechanical ventilation. Children's Hospital of New York (Columbia University) places all spontaneously breathing infants on nasal prong CPAP as the first mode of respiratory support. The early initiation of nasal prong CPAP in combination with a tolerance to elevated PCO(2) levels has reduced the incidence of chronic lung disease to <5% in infants weighing less than 1500g. This report will present an historical review and summarize the experience with CPAP at Columbia and other centres. In addition, it reviews the clinical applications and physiological effects of CPAP in preterm infants with respiratory distress syndrome.

Hospitals, Pediatric↗