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At least 19 recordsLinked to original sources
PubMed1997

Managing case management across the continuum: an organized response to managed care.

Case management is a core strategy for providing high-quality, cost-effective care in a managed care environment. Acute care case management programs most often originate as nursing-driven, hospital-based initiatives. Given the overwhelming trend toward vertical integration of health care organizations, hospital-based case management programs may be only an interim step toward a longer term strategy. Hospital and case management program leadership should consider how existing case management models can expand to meet patient and provider needs in an integrated health system or network environment. Key issues and strategies for designing a case management system based on continuum of care are described.

Case Management↗
PubMed1996

Epoetin alfa--focus on nursing case management. Case study of the anemic patient.

Case management is a multidisciplinary collaborative approach that emphasizes continuity of patient care. Nursing case management can lead to improvements in the quality of care while affording nurses the opportunity to increase their expertise, autonomy, and authority in the health care system. Treatment of the anemia of end-stage renal disease (ESRD) is used as an example to illustrate the implementation of these principles in the dialysis unit.

Anemia, Iron-Deficiency↗
PubMed1995

Cracked teeth--treatment rationale and case management: case reports.

The treatment rationale for, and successful management of, six teeth with cracks in the form of incomplete vertical fractures are reported. Further crack propagation was prevented by placement of either stainless steel orthodontic bands or aluminum or acrylic resin provisional crowns, and endodontic treatment was subsequently carried out. The teeth were restored with intraradicular amalgam cores and complete veneer crowns. The teeth were reexamined periodically for up to 3.5 years after treatment. During the period of review, all teeth remained asymptomatic.

Adult↗
PubMed1995

Utilization management, case management, and you.

Historically, most monitoring functions have been carried out by insurance companies. Monitoring costs was considered their fiduciary obligation to their customers. The exercise of this fiduciary obligation kept premiums low, while increasing or maintaining the benefit levels. Risk (the assumption of losses generated by services costing more than the income received from premiums) was assumed by the insurance company and eventually passed to the customer or the payer. Today, risk is being transferred more and more to the provider. This transfer was started by the creation of DRGs, the main purpose of which was to transfer risk from payers (insurance companies, employers, state and federal government, etc.) to provider health care organizations (physician groups, individual practitioners, hospitals, clinics, etc.).

Cost Control↗
PubMed1990

A social work practice model of case management: the case management grid.

Case management is a major component of the current mainstream of social work practice. Nevertheless, the field has failed to adequately conceptualize case management. The first step in defining case management practice is to separate it from the administrative structure that forms the context of practice. The next step is to delineate the two basic dimensions of case management--enabling and facilitating. The role of the social work case manager is to integrate formal systems of care with the activities of families and primary groups. Case management practice focuses on enabling individuals and primary groups to reach their full potential and on facilitating more effective interaction with the larger social environment. The case management grid illustrates how social work practitioners integrate enabling and facilitating into their practice approaches.

Humans↗
PubMed1998

Research directions for case management.

Case management is a worldwide phenomenon and depending on the particular country's organizational framework of the health and social system, many models have been developed. The definitions of case management vary, but all of the models being developed aim to provide holistic quality care that is cost-effective. Reviewing the various components of case management is important because they contribute to the success or failure of providing quality, cost-effective care. The geographical setting where case managers work (i.e., hospitals or community/home), and the level of fiscal authority given to the case managers are two important components of case management models. Whether there is a conflict between case managers acting as advocates of clients while at the same time being the gatekeeper of funds is an area that needs exploration. The question is can the two notions be "married" as opposed to being inherently conflicting, and can case managers act in the best interests of the clients. There are many research directions for case management, including which aspects of the model ultimately have positive results for the client and health and social system.

Case Management↗
PubMed1994

The managerial nature of case management.

Case managers have been viewed as engaging in direct practice, community practice, or both. This article offers a third view: Case managers also engage in the practice of management. Employing Mintzberg's seminal research on chief executive behavior, the authors argue that case managers' work is similarly characterized by brevity, variety, and fragmentation. Case managers perform the 10 roles developed in Mintzberg's original study. These roles are divided into three groups: interpersonal, including figurehead, leader, and liaison; informational, including monitor, disseminator, and spokesperson; and decision-making, including entrepreneur, disturbance handler, resource allocator, and negotiator. Case managers' tasks associated with each role are presented. Considering their work as managerial in nature will help case managers more effectively assist clients in goal achievement.

Health Resources↗
PubMed1997

Personal assistance services and case management.

Case managers can serve a vital role in the coordination and support of consumer-driven personal assistance services (PAS) for people with disabilities. Personal assistants provide services such as assistance with mobility needs, transferring in and out of a bed or wheelchair, bathing, dressing, grooming, toileting, preparing meals, check writing, and communication interpretation. Maximum independence and autonomy are often achieved when disabled people manage the services that they need. By focusing case management on doing what the individual directs, the case manager can enhance independence, autonomy, and accommodation. In response to needs identified by its members, the Paralyzed Veterans of America (PVA) began to develop a comprehensive PAS training program for institutions, agencies, families, and individuals. The Independent Living Training Program is based on an approach to PAS that incorporates a case management model that supports the principles of consumer empowerment and self-determination.

Activities of Daily Living↗
PubMedDate not supplied

Communication: an outcome of case management.

Case management is a healthcare delivery model emphasizing coordination and networking of patient care services across multidisciplinary providers and various care settings. This requires effective communication to overcome traditional barriers to information exchange. This study investigates communication as an outcome of case management. The classic communication model of sender-message-channel-receiver is used as a conceptual framework. Using a closed medical record review, the amount and type of referral information exchanged between a hospital using a case management model to coordinate care and a home health agency accepting the case-managed patient is described. In addition, the influence of selected organizational and medical condition factors on communication is explored.

Case Management↗
PubMedDate not supplied

Patterns of health resource utilization, costs, and intensity of need for primary care clients receiving public health nursing case management.

Case management has been promoted as a managed care strategy that improves quality of care and contains costs. Health resource utilization patterns and associated costs were examined for a generalized primary care population receiving a public health nursing model of case management intervention during a 30-week period. Subjects were referred by providers practicing in an academic health science center and included two client subsamples: chronically ill adults and younger families requiring health maintenance. Health resource utilization patterns and associated costs were examined in relation to intensity of need for care levels as determined by the Community Health Intensity Rating Scale. Results of this pilot study suggest that during public health nursing case management intervention, health resource utilization patterns changed from the preintervention period. Total health resource utilization costs were correlated with care needs related to health management behavior of the chronically ill.

Adult↗
PubMed1998

The Omaha System: a model for describing school nurse case management.

Case management is a key role for school nurses to employ in effecting positive outcomes for students in both health and education. The purpose of this paper is to describe the Omaha System and demonstrate its usefulness as a tool for school nurse case management. A case study model was used to analyze the practice of a single school nurse. During the 1995-1996 school year, the Omaha System helped a school nurse to identify students' health problems utilizing the Problem Classification Scheme, and the Intervention Scheme helped identify the nursing interventions employed. The Problem Rating Scale for Outcomes is also discussed in relation to this particular school nurse's practice.

Case Management↗
PubMedDate not supplied

Defining case management.

Case management is a frequently used term in nursing; however, it is not easily defined. The discussion that follows examines the various meanings of case management and the roles of the case manager.

Humans↗
PubMed1992

Adolescent pregnancy and early intervention programs benefit from case management.

Case Management methods are being adapted to effectively serve two vulnerable populations: pregnant and parenting adolescents, and infants and toddlers with disabilities of developmental delay and their families. This article describes the case management model developed by California's Adolescent Family Life program and discusses issues related to providing family-centered, community-based case management in early intervention programs.

Adolescent↗
PubMed1997

Oxygen protocols for the prevention of hypoxemia. A review for case managers.

Case managers are challenged by the need to ensure quality care for patients in the face of increasing demands on the health care system to provide more economic care. These economic pressures often cause hospitalized patients to be transferred from critical care areas earlier than in years past. As a result, hypoxemia-inadequate oxygenation of the blood-is emerging as a serious patient safety problem in noncritical care areas of the hospital. The medical literature recently has begun to document hypoxemia in some patient groups on the general care floor, where continuous monitoring of patients' respiratory status usually is no longer employed. The serious health consequences of hypoxemia, the fact that it can affect nearly any hospitalized patient, and the potentially high cost of treating hypoxemia-related morbidity are drawing the attention of the medical community. Case managers are in a position to address this emerging problem by working with hospitals and health care institutions to identify at-risk patients and develop strategies to improve both clinical and financial outcomes. Patient care protocols are one effective strategy to standardize monitoring of patients deemed to be at risk. Early detection and treatment of hypoxemia have the potential to improve patient care while significantly reducing medical costs.

Case Management↗
PubMed2001

Catastrophic case management. A case study.

For the best clinical outcomes, catastrophic case management begins within the critical/intensive care units. The critical care nurse can facilitate this process by (1) documenting clearly, concisely, and legibly the patient's status in a holistic manner, as much of this information will be used to translate complex medical verbiage to clinical outcomes for financial authorization; (2) providing a receptive environment for the rehabilitation nurse case manager; (3) supporting the role of the rehabilitation nurse case manager in communications with the patient and family; (4) providing professional courtesy and dialogue when interacting with the rehabilitation nurse case manager; (5) understanding that although roles are different, the rehabilitation nurse case manager provides the continuous coordination of services and resources for optimal outcomes, and (6) including the rehabilitation nurse case manager in team or patient conferences so problems can be identified, allowing rehabilitation goals to be modified or expanded. Frequently, the rehabilitation nurse case manager is aware of the limitations of the health plans or capitated financial limitations of the benefit plans. With an informed understanding of the patient's problems, planning will maximize resources to achieve the best possible outcomes. For example, some benefits have a maximum number of home care visits annually or do not include acute rehabilitation hospitalization within the benefit plans. By matching the patient's needs to the benefit services within the time frame, resources are maximized. Most people are not aware of their health care plan services until the need arises. A rehabilitation nurse case manager possesses the expertise to advocate, negotiate, and use the benefits fittingly.

Accidents, Occupational↗
PubMed1994

Case management: managing the nurse case manager.

Nurse executives and nurse managers have become proactive in response to the health care crisis by creating and implementing innovative health care delivery models such as nursing case management. Nursing case management utilizes a nurse as case manager and the unit-based system of managed care to achieve financial and clinical outcomes for target patient groups. Nurse managers can support the nursing case management model best by practicing good managerial skills, developing a participative style of leadership, and empowering the nurse case manager.

Employee Performance Appraisal↗
PubMedDate not supplied

A decentralized model for case management.

Case management has been implemented in a variety of health care settings. The implementation of case management at one hospital, including rationale for selection and outcomes, is described here. A decentralized model emphasizing staff nurse control is recommended for hospitals with TQM and shared governance programs already in place.

Decision Making, Organizational↗