community week 9
lilyalonso
CHNChapter_009.pptxChapter 9
Case Management
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Case Management …
“… is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.”
– The Case Management Society of America (2009)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nursing Case Management …
… is “a dynamic and systematic collaborative approach to provide and coordinate health care services to a defined population. The framework includes five components: assessment, planning, implementation, evaluation and interaction.”
– American Nurses Credentialing Center, ANA
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Care Management
Overall goal: Improve the coordination of services provided to clients who are enrolled in a care management program.
A collaborative process
An emerging concept that is…
evidence based
patient centered
clinical care focused
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Care Coordination
Target chronically ill persons at risk for adverse outcomes and expensive care
Identify full range of problems that increase patients’ risk of adverse health events
Educate in self-care, optimization of treatment, and integration of care
Monitor patients for progress and early signs of problems
Hope to raise quality of care, improve health outcomes, and reduce need for costly hospitalizations and medical care
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Patient-Centered Medical Homes
Seven characteristics:
Patient’s relationship with primary care physician
Physician-led, team-based care
“Whole persons” require comprehensive care at various stages of life
Integration and coordination of care
Quality and safety
Improved access to care
Payment system that accurately reflects the efforts and care provided by the team
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Purposes of Case Management
Client centered
Help the client through a complex, fragmented, and often confusing health care delivery system and achieve specific client-centered goals.
System-centered
Recognizes that resources are finite
Promote cost-effective, high-quality care
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Possible Case Management Functions
Identifying the target population
Determining screening and eligibility
Arranging services
Monitoring and follow-up
Assessing
Planning care
Reassessing
Helping clients through a complex, fragmented health care system
Care coordination and continuity
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Case Managers
Must have appropriate educational background
A minimum skill level is needed to ensure success in the role
Certification as a case manager is available
Case Management Association of America (CMSA)
American Nurses Credentialing Center (ANCC)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Role Functions of Case Managers (CMSA, 2002)
Essential activities of case management
Assessment
Planning
Facilitation
Advocacy
Collaboration
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Case Management in Community Health
Community case management models
Public health clinic settings
Occupational health settings
High-risk clinic settings
Clients with chronic diseases
Home health and hospice
Case management research
International settings
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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