NURSING CASE NURSING CASE MANAGEMENTMANAGEMENT
A A COMMUNITY andCOMMUNITY and PUBLIC HEALTH MODELPUBLIC HEALTH MODEL
By Nataliya Haliyash, By Nataliya Haliyash, MD, BSNMD, BSN
TSMU, International Nursing SchoolTSMU, International Nursing School
IntroductionIntroduction
Case Management model designed for use in: population approach community setting complex clients (disease management)
Nurse case management - a strategy Nurse case management - a strategy for care co-ordinationfor care co-ordination
“ “ A role and process that focuses on A role and process that focuses on
procuring, negotiating, and coordinating the procuring, negotiating, and coordinating the
care, services, and resources needed by care, services, and resources needed by
individuals with complex issues throughout individuals with complex issues throughout
an episode or continuum”an episode or continuum”
Bower, K. (1996)
Case managementCase management
strategy to coordinate care through a process strategy to coordinate care through a process of managing quality, access, and cost to of managing quality, access, and cost to manage the risks with vulnerable groups.manage the risks with vulnerable groups.
(Yoder-Wise, 1999) It involves face-to-face relationships across a
variety of health care agencies and services and their representatives.
Case managementCase management
is an area of practice within several healthcare is an area of practice within several healthcare professions. Most case managers are nurses or professions. Most case managers are nurses or social workers.social workers.
The term case management is also used to refer to The term case management is also used to refer to dispute resolution systems which provide court or dispute resolution systems which provide court or tribunal officials with closer administrative control tribunal officials with closer administrative control over the litigation process than is traditionally over the litigation process than is traditionally associated with common law litigation.associated with common law litigation.
Case managementCase management
The Case Management Society of America The Case Management Society of America defines case management as:defines case management as:
"a collaborative process of assessment, "a collaborative process of assessment, planning, facilitation and advocacy for planning, facilitation and advocacy for
options and services to meet an individual's options and services to meet an individual's health needs through communication and health needs through communication and
available resources to promote quality cost-available resources to promote quality cost-effective outcomes."effective outcomes."
Case Management goals:Case Management goals:
Enhance health status and functionality of clients;
Maximize client access to services; Use resources cost-effectively; Integrate & coordinate services provided by
multiple disciplines
Cohen (1996)
Five Principles of Five Principles of Nursing Case ManagementNursing Case Management
Focuses on clients and families with complex issues Involves negotiation, coordinating, and procuring
services and resources Entails using a clinical reasoning process Network development of multi-disciplinary relationships Is episode- or continuum-focused
Cohen, E (1996)
For community health nurses, this has been the method of caregiving for more than 100 years.
However, it was introduced in the acute care setting, with enthusiasm, in the 1990s as a “delivery innovation” and a panacea for harnessing escalating costs and insurance premium increases.
(Powell, 2000)
HospitalHospital
SanatoriumSanatorium
CommunityCommunity
Nurse case management in the Community Setting
Health promotion & disease prevention Prevent escalation of client condition Comprehensive & collaborative care Efficient use of health care services Practice guidelines, clinical pathways &
client/family outcomes improve effectivity
The Case Management Process
Case finding & risk appraisal Nursing interventions matched against
characteristics & needs of the risk group Co-ordination of services & continuum of
care Evaluation of individual & group outcomes
Bower, K. (1992) & Mullahy, C.M. (1995)
WIDER COMMUNITY
WORK & PLAY
WHANAUCLIENT
HOSPITAL
MO’S/PHMS
OTHER PHN’S
SOCIAL AGENCIES
NURSE
NURSE
Strengths Strengths
Good collaboration – nurse/client/doctors/services
Focuses on prevention Highlights health promotion Treatment becomes an integral part of
daily life for our client
WeaknessesWeaknesses
Dependent upon individual nurses’ skills/perseverance/initiative
Educational requirements vs the demands of the role
Nurses often feel ill-prepared to offer basic instruction/support in health promotion & prevention
Optimum Example
Benefits & Outcomes
Question: Where on the continuum do the clients access
services? How do we measure prevention? How do we measure health promotion? What changes are needed to realise these
benefits?
Why measure outcomes? Dramatic shifts in health care delivery is
being driven by changes in reimbursement
It is more cost effective to treat populations by using epidemiological and public health models rather than treating individuals or families/whanau
Challenges in Measuring Outcomes
Client confidentiality I.T. development of user friendly software Nurse’s need to adapt health care practice
to modern-day technology Population-based care requires healthcare
providers work together
Examples of Outcomes Measurement
Quality Outcomes Cost Outcomes Comparison studies to show contrast Measuring the complexity of needs
Lessons Learned
Central to this model are:
Collaboration Networking Keeping the client & family/whanau at the centre of care Public health nurses have become pro-active in the
development of strategies that are core to the health care management of high-risk populations eg. Case management
Multi-disciplinary team approaches National and International planning
BibliographyBibliography
Bower, K. and C. Falk (1996). Case Management as a Response to Quality, Cost, and Access Imperatives. Nurse Case Management in the 21st Century. E. Cohen. St. Louis, Mosby: 161-166.
Cohen, E. (1996). Nurse Case Management in the 21st Century. St Louis, Mosby.
Cohen, E. and T. Cesta (1997). Nursing Case Management; from concept to evaluation. St Louis, Mosby.
Donabedian, A. (1990). “The Seven Pillars of Quality.” Arch Pathol Lab Med 114: 1115 - 8.
Etheredge, M. L. (1989). Collaborative Care Nursing Case Management. (American Hospital Association), American Hospital Publishing, Inc.
Kersbergen, A. L. (1996). “Case Management: a rich history of coordinating care to control costs.” Nursing Outlook 44(4): 169-72.
Zander, K. (1990). Patient Care Delivery Models. Rockville, MD: Aspen Publishers.
External linksExternal links
Case Management Software Solution http://www.handelit.com/
Commission for Case Manager Certification Case Management Society of America American Case Management Association
http://www.acmaweb.org/ Case Management resources On the Case from minoritynurse.com
He aha te mea nui ki He aha te mea nui ki te Ao?te Ao?
He tangata, he tangata, he tangata
What is the mostWhat is the mostimportant treasure onimportant treasure onearth?earth?
It is peopleIt is peopleIt is people
