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Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, part II.

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004 for the purpose of validating the currency and relevancy of the certified case manager examination. The results of this study are shared in an article of 2 parts. Part I, which was published in the previous issue of this journal, discussed the process the CCMC used for the development of the Case Managers' Role and Functions Survey Instrument and the identification of new 6 essential functions and 6 knowledge areas that describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the results and focuses on identifying the empirical (statistically derived) activity and knowledge domains of case management practice, using exploratory factor analysis. It discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, Part II summarizes future changes in the field of case management as perceived by those who participated in the study.

Adult↗

Moneymed: a game to develop management skills in general practice.

A game has been developed to train people in the financial and administrative skills needed for effective general practice management. These skills cover a wide range of legal, economic, administrative and personnel problems encountered in general practice. Thirty-four trainees and six trainers showed a highly significant improvement in knowledge and problem-solving skills after playing the game. The format and design of the game allow the problem type, complexity and solution to vary and to be readily updated. So far, this seems to be one of the most effective instruments yet developed for learning these skills.

Education, Medical, Graduate↗

A simple technique for data management in general dental practice audit.

General practice audit is essential in the process of developing an evidence-based approach to dental care. The CHAID (CHi-Squared Automatic Interaction Detector) statistical software package is both practical and user-friendly for many simple applications. The types of questions asked in general practice audit projects will frequently be suitable for analysis using this technique. This may include the identification of patients who are likely to fail appointments and place an additional financial burden on the practice. This paper illustrates the potential value of CHAID to general dental practitioners (GDPs) by using examples of commonly cited dental audit topics. This paper aims to illustrate how a simple statistical package (SPSS CHAID) may be of use for both audit and practice management activities.

Appointments and Schedules↗

Human resource management in general practice: survey of current practice.

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change.

England↗

A national survey to define a new core curriculum to prepare physicians for managed care practice.

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of curricular components exist but in s some cases needed to be modified to more clearly relate to managed care practice, and that their findings may provide a useful starting point for making decisions about curricular reform.

Curriculum↗

Quality managing in practice--using ISO 9002.

The value of an International Quality Standard in Orthodontic Practice is discussed. The nature of the process is described and relevant sources presented for further exploration of the subject. The relevance of ISO 9002 to orthodontic practice is highlighted.

Certification↗

Using evidence-based practice for managing clinical outcomes in advanced practice nursing.

Preparation of advanced practice nurses to assume leadership positions for clinical decision making requires that traditional ways of solving clinical problems be augmented with information from relevant, research-derived evidence. In this article, the authors describe how one graduate program prepares advanced practice nurses to use the best scientific evidence with clinical expertise to influence patient outcomes. The assignments that students complete in their program provide examples of evidence-based practice that apply quality improvement principles and science-based nursing interventions to create best practices.

Education, Nursing, Graduate↗

Managing your practice's first impression: the process of front-desk reengineering.

Patients must be regarded as consumers. As such, they are increasingly informed, questioning, cost-conscious, technologically savvy, and demanding. Just as health plans have developed defined contribution products that offer consumers more control over how and where their health-care dollars are spent, practice success is linked to reengineering office operations to offer consumers and patients greater choice, control, autonomy, and service. Patients and consumers want practices that deliver clinical and business services that meet the criteria of reliability, effciency, service offerings, patient focus, enthusiasm, customization, and trust. Physician practices must also take care to avoid destructive and disruptive behaviors and conditions such as noise, interference, excessive repetition, long waits, appointment delays, and staff rudeness. A successful patient-focused practice emerges when physicians and office staff begin to look at the clinical and service experience through the patient's eyes.

Efficiency, Organizational↗

Panel discussion: remedy effectiveness: what works, what doesn't?

As contaminated sediment sites in freshwater and marine environments come under increasing scrutiny, and the importance of these sites with regard to ecological and human health is better understood, the number of contaminated sediment sites requiring risk characterization and management is increasing. Risk reduction must be the long-term goal of all sediment management practices. Risk management strategies in aquatic environments focus on mitigating potential exposure pathways for contaminants that may pose an ecological or human health risk over time. Sediment management practices include dredging ("environmental dredging"), capping, monitored natural recovery, and combinations of these generic response actions. A Remedy Effectiveness Panel was selected to identify and discuss the key issues associated with the performance of these generic response actions for contaminated sediments. The panel convened in New Orleans on 26 January 2005 at Battelle's Third International Conference on the Remediation of Contaminated Sediments and made 3 presentations on response actions to conference attendees followed by an open dialog between attendees and panel members. This article introduces the 3 generic response actions, identifies key topics from the open dialog and presents opinions expressed, and provides a summary and observations.

Ecology↗