A Comparative Effectiveness Study in Health Care Management of Neurosurgery Patients by Bangkok International Hospital Case Manager Nurse

Abstract

OBJECTIVES: To compare effective health care management practices, with a focus on three dimensions consisting of internal process, utilization management (UM) and financial management (FM) between patients who received clinical coordination interventions by case management (CM) nurse and usual standard of care of neurosurgery patients at Bangkok International Hospital (BIH). MATERIALS AND METHODS: This study is a retrospective chart review. This research collected data from neurosurgical patients, namely confirmed cases by neurosurgeons. They have undergone brain surgery procedures and have been admitted to BIH during a period of 3 years from 1st January 2019 - 30th June 2022. We compared the outcome variables between two groups (The control group received usual care and the post-intervention group received clinical coordination by CM nurse) to assess the effectiveness of health care management. This consisted of the internal process, UM and FM. These data were analyzed using statistics with descriptive statistics and the independent t-test. RESULTS: Of a total of 372 neurosurgical cases, 235 cases (63.2%) met the inclusion criteria. More than half of cases were male (58.3%). The mean age was 60.6 ± 16.6 years. Most of them 181 (77.0%) were admitted to the neuro ward. The diagnosis included Stroke 100 (42.5%), Brain Tumor 86 (36.6%) and Traumatic Brain Injury (TBI) 27 (11.5%), respectively. The post-intervention group presented obviously higher compliance rates of 87.2% with a patient/family care team meeting and 79.2% discharge planning, respectively. The post-intervention group had lower costs (0.1%) of Risk Management than the control group (0.4%). Meanwhile, the control group had lower cost of bad debts expenses per year than the post-intervention group. That may have been an effect of some patients in the post-intervention group not having an insurance coverage of 100% of medical costs and could not afford the care. The comparison of the LoS in the control group showed significant differences, and less than those in the post-intervention group (p < 0.05). CONCLUSION: These results indicate that CM nurses can decrease risk management costs. Although, this study does have limitations. We have seen a positive trend towards using our CM model as this can assist in the improvement of quality in health care management through an effective care team meeting and discharge planning for our neurosurgical patients and their family. However, future studies should control confounding variables and more study is needed into other factors that may affect clinical outcomes.