Statistical and methodological issues in the evaluation of case management studies.
For the past 3 years, the nursing case management team at North Shore University Hospital in Manhasset, NY, has been involved in a project to implement more than 50 clinical pathways, which provide a written "time line" for clinical events that should occur during a patient's hospital stay. A major objective of this project was to evaluate the efficacy of these pathways with respect to a number of important outcomes, such as length of stay, hospital costs, quality of patient care, and nursing and patient satisfaction. This article discusses several statistics-related issues in the design and evaluation of such case management studies. In particular, the role of a research approach in implementing and evaluating hospital programs, the choice of a comparison (control) group, the exclusion of selected patients from analysis, and the problems of equating pathways with diagnosis-related groups are addressed.
Lesser
M L
ML
North Shore University Hospital, Manhasset, NY, USA.
Robertson
S
S
Kohn
N
N
Cooper
D J
DJ
Dlugacz
Y D
YD
D019090:Case Management / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D019091:Critical Pathways; D003625:Data Collection; D003953:Diagnosis-Related Groups; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay; D009518:New York; D009738:Nursing Service, Hospital / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D015397:Program Evaluation; D012985:Software Design