Milliman & Robertson enhances products
M&R Guidelines
update for hospital case managers
Milliman & Robertson enhances products
By Richard L. Liliedahl, MD
Senior Vice President and Chief Medical Officer
Barbara Porter, MA
Vice President, Sales and Marketing
M&R Care Guidelines, A Division of Milliman &
Robertson Chicago
The M&R Care Guidelines describe the best practices for treating common conditions in a variety of care settings. The Guidelines are used as tools by health care professionals in medical decision-making for a patient in a hospital, in a doctor’s office, in a patient’s home, or in other care facilities. Inpatient and Surgical Care is the principal product used in hospital settings. This product provides guidelines on more than 400 conditions. The current portfolio of M&R Care Guidelines products comprises nine publications that span the continuum of patient care.
The Guidelines are written by Milliman & Robertson clinicians and represent a compilation of best practices drawn from medical literature, practice observation, and the expert opinion of physicians, nurses, and other providers. The purpose of these clinical tools, which are updated on a regular basis, is to assist health care professionals in providing quality care while maximizing the medical community’s efficiency in the use of health care resources.
The M&R Care Guidelines Division has focused on several issues of importance to hospital case management needs for the coming year. These are:
• market research to better understand the needs of hospital case managers and other key medical management personnel;
• an increased focus on education regarding appropriate use of Guidelines for all our Guidelines users;
• product enhancements and additions to meet the needs of hospital users.
Market Research
Market research was conducted across all product lines and for different markets, including the hospital market. Findings revealed a need for additional content within the existing product lines. These include:
• information to address the complex patient;
• easier to read information;
• easier to locate relevant information;
• more specificity within guidelines, and written at the experienced case manager’s level;
• additional information on drug tables, imaging, expanded discharge plans, quality measures, and psychosocial issues.
Education
The M&R Care Guidelines Division also increased its emphasis on educating our customers regarding the best and most appropriate use of the Guidelines to provide the best quality care to all patients. We have been providing:
• education within the Guidelines publications themselves with descriptive information on appropriate use;
• Guidelines seminars available to clients and other health care professionals across the United States;
• client-specific training conducted by M&R consultants;
• an annual User Group Forum for all users who have purchased the Guidelines.
Increased attention is now being directed to developing more comprehensive information regarding appropriate use, frequently asked questions, and editorial replies to journals and other articles, which will be posted on our Web site (www.mnr.com). Our licenses with all Guidelines users contain specific information describing appropriate use of the Guidelines.
Two areas of education we have specifically focused on are the Goal Lengths of Stay and our Evidence Based Medicine Guidelines development process. The Goal Length of Stay is a description of what is possible for a hospitalized patient who has no complications and has an optimal recovery. It is not to be confused with average length of stay and is not intended to apply to all patients. Data on different populations show 40% to 80% of patients now achieving that Goal Length of Stay in several states.
Our other educational focus has been on our evidence-based medicine development process. Written by Milliman & Robertson clinicians, the Guidelines are founded on the use of evidence-based research methodology to support the development and understanding of medical care processes. Milliman & Robertson takes its definition of evidence-based medicine from David Sackett’s article, "Evidenced Based Medicine: What It Is and What It Isn’t," which appeared
in the British Medical Journal in January, 1996: "Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."1
Sources of information for all M&R Care Guidelines include: medical literature and textbooks and nationally recognized guidelines published in all fields of medicine, practice observations, and database analyses. In weighing and grading the evidence, Milliman & Robertson uses the following generally accepted hierarchy of evidence, with the first level being the most important:
• Evidence Grade 1: Randomized controlled trials.
• Evidence Grade 2: Other published sources.
• Evidence Grade 3: Unpublished research, large databases, quality improvement projects, expert practitioner reports.
Product Enhancements
Our product changes likely to be of most interest to the hospital case manager include:
• an annotation of the literature used in our development process, with assorted references allowing providers to access this literature for their own quality improvement projects;
• extended stay and complications sections added to Inpatient Surgical Care 2000 and Facility Care updates;
• an expanded Case Management section, including Hospital, Prevention, Office or Rapid Treatment Site, and Home Care, which identifies key elements of care;
• focus on the case manager’s needs, with guidelines organized by body system, and including key information case managers need to assist patients effectively and efficiently through the continuum of care;
• reformatted Case Management: Home Care (CMH) and Case Management: Recovery Facility Care (CMR) to make them easier to read, with bulleted information and easily identified sections;
• clinical detail, documented from best practices, to help case managers provide the best care for complex patients;
• a continued focus on the continuum with descriptions of the complicated patient in our CMR product;
• rigorous documentation of the evidence in all our products to support the user in making decisions and educating patients, families, and health care professionals;
• continued aggregate data models to help hospitals look at opportunities for improvement;
• visit and treatment recommendations in CMH that take into consideration the new OASIS requirements for extensive data collection;
• new, key information documented from best practices on imaging, expanded discharge plans, quality measures, and psychosocial factors.
New Products
One new product, the Case Managers Companion, is a pocketbook of information condensed from three of the Guidelines publications, including Inpatient and Surgical Care and reformatted to meet the hospital case manager’s needs. Another new product, called CareGuideQI, is an interactive guideline and decision-support tool. While the Guidelines help clients coordinate care throughout the continuum, CareGuideQI helps your organization measure application of the Guidelines, enabling you to manage health care delivery as well as risk.
These product improvements should help all hospitals improve their patient care management processes and their patient record documentation, as identified in our market research. For information on M&R’s products, please contact Richard Liliedahl, MD, senior vice president and chief medical officer, at (206) 381-8131, or Barbara Porter, MA, vice president of sales and marketing, at (206) 381-8140. Milliman & Robertson’s Web site address is www.mnr.com.
Reference
1. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: What it is and what it isn’t: It’s about integrating individual clinical expertise and the best external evidence. BMJ 1996; 312:71-72.
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