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Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program

In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re...

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Autores principales: Rousseau, Robert, Weisberg, Daniel F., Gorero, Jack, Parwani, Vivek, Bozzo, Janis, Kenyon, Kathleen, Smith, Constance, Cole, Joanna, Curtis, Susanna, Forray, Ariadna, Roberts, John D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380627/
https://www.ncbi.nlm.nih.gov/pubmed/32706825
http://dx.doi.org/10.1371/journal.pone.0236360
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author Rousseau, Robert
Weisberg, Daniel F.
Gorero, Jack
Parwani, Vivek
Bozzo, Janis
Kenyon, Kathleen
Smith, Constance
Cole, Joanna
Curtis, Susanna
Forray, Ariadna
Roberts, John D.
author_facet Rousseau, Robert
Weisberg, Daniel F.
Gorero, Jack
Parwani, Vivek
Bozzo, Janis
Kenyon, Kathleen
Smith, Constance
Cole, Joanna
Curtis, Susanna
Forray, Ariadna
Roberts, John D.
author_sort Rousseau, Robert
collection PubMed
description In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%). Providers and nurses viewed the re-organization and outcomes positively. Most patients reported improvements in pain control and life style; many patients thought the re-organization process was unfair. Their primary complaint was a lack of shared decision-making. We attribute the contrast in these perspectives to the inherent difficulties of managing recurrent acute and chronic pain with opioids, especially within the context of the imbalance in wellness, power, and privilege between persons living with sickle cell disease, predominantly persons of color and poor socio-economic status, and health care organizations and their personnel.
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spelling pubmed-73806272020-07-27 Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program Rousseau, Robert Weisberg, Daniel F. Gorero, Jack Parwani, Vivek Bozzo, Janis Kenyon, Kathleen Smith, Constance Cole, Joanna Curtis, Susanna Forray, Ariadna Roberts, John D. PLoS One Research Article In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%). Providers and nurses viewed the re-organization and outcomes positively. Most patients reported improvements in pain control and life style; many patients thought the re-organization process was unfair. Their primary complaint was a lack of shared decision-making. We attribute the contrast in these perspectives to the inherent difficulties of managing recurrent acute and chronic pain with opioids, especially within the context of the imbalance in wellness, power, and privilege between persons living with sickle cell disease, predominantly persons of color and poor socio-economic status, and health care organizations and their personnel. Public Library of Science 2020-07-24 /pmc/articles/PMC7380627/ /pubmed/32706825 http://dx.doi.org/10.1371/journal.pone.0236360 Text en © 2020 Rousseau et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rousseau, Robert
Weisberg, Daniel F.
Gorero, Jack
Parwani, Vivek
Bozzo, Janis
Kenyon, Kathleen
Smith, Constance
Cole, Joanna
Curtis, Susanna
Forray, Ariadna
Roberts, John D.
Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title_full Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title_fullStr Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title_full_unstemmed Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title_short Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
title_sort utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380627/
https://www.ncbi.nlm.nih.gov/pubmed/32706825
http://dx.doi.org/10.1371/journal.pone.0236360
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