IMPLEMENTATION OF AN INPATIENT CASE-MANAGEMENT PROGRAM IN RURAL HOSPITALS

The objective of the study teas to identify factors that affected the implementation ion of an inpatient case measurement program In rural h ospitals, Tile hospitals studied were from the Western New York Rural Health Care Cooperative. Five of the hospitals implemented the program in 1992. A qualitative evaluation was conducted by analyzing tape-rec orded interviews with nurses and chief executive officers to identify obstacles to and facilitators of program implementation. Many obstacle s to implementation could be traced to workload and time constraints, physician autonomy concern, and limited nursing staff and physician pa rticipation. Implementation was facilitated foremost by the effort and supportive attitudes of nursing leaders and hospital chief executive officers. This study concluded that it should be possible to successfu lly implement conceptually sound managed cave and case management prog rams in rural hospitals, but it will require a relatively long period of support, especially from hospital administration and nursing leader s.