INTRODUCING CASE-MANAGEMENT TO A GENERAL MEDICINE WARD TEAM OF A TEACHING HOSPITAL

Purpose. To introduce case management to a general medicine ward team of a teaching hospital to improve patient care and ensure comprehensiv e longitudinal care. Method. The Department of Veterans Affairs Medica l Center is one of four hospitals used by University of Oklahoma Schoo l of Medicine residents. There are five medicine teams, each comprisin g a second- or third-year resident, one or two interns, two medical st udents, and a faculty physician. The case-management program was initi ated in November 1994. No attempt was made to limit the residents assi gned to the case-managed team (i.e., many residents who worked with th e case-managed team subsequently rotated through the other teams). Pat ients were assigned to the teams by rotation, and no attempt was made to adjust for the severity of illness among admissions. The teams were separated as follows: pre-case-management teams (all five teams prior to the case-management program), non - case-management teams (the fou r teams without case managers after the program's initiation), and the case-management team. The study periods were January-July 1994 (pre-c ase management) and January-July 1995 (after case management). Results . The numbers of patients treated by the three groups were 1,305, 1,13 9, and 289, respectively. The median length of stay for pre-case-manag ement patients was 5 days (interquartile range, 3-9 days); for non-cas e-management patients, 5 days (range, 3-8 days); and for case-manageme nt patients, 5 days (range, 3-7 days). The cumulative distribution of lengths of stay for case-management patients was significantly differe nt from those of the other study groups by the Kolmogorov-Smirnov test (p = .02). More case-management patients were discharged by day 7. Ra tes of readmission were not significantly different between the teams. Conclusion. In this study a case-management program was effectively i mplemented in a teaching hospital, resulting in reduced lengths of sta y for patients. As academic health centers become more concerned with efficiency and cost, case management should be seriously considered as a way to deal with such issues.