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

WHANAU

CLIENT

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 most

important treasure onimportant treasure on

earth?earth?

It is people

It is people

It is people