NURSING CASE MANAGEMENT

1. NURSING CASE MANAGEMENT A COMMUNITY and PUBLIC HEALTH MODEL By Nataliya Haliyash, MD, BSN TSMU, International Nursing School

2. Introduction Case Management model designed for use in: • population approach • community setting • complex clients (disease management)

3. Nurse case management - a strategy for care co-ordination “ A role and process that focuses on procuring, negotiating, and coordinating the care, services, and resources needed by individuals with complex issues throughout an episode or continuum” Bower, K. (1996)

4. Case management strategy to coordinate care through a process of managing quality, access, and cost to 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.

5. Case management • is an area of practice within several healthcare professions. Most case managers are nurses or social workers. • The term case management is also used to refer to dispute resolution systems which provide court or tribunal officials with closer administrative control over the litigation process than is traditionally associated with common law litigation.

6. Case management The Case Management Society of America defines case management as: "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

7. 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)

8. Five Principles of Nursing 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)

9. 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)

10. Hospital

11. Sanatorium

12. Community

13. 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

14. 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)

15. WIDER COMMUNITY NURSE WORK & PLAY WHANAU CLIENT HOSPITAL MO’S/PHMS OTHER PHN’S SOCIAL AGENCIES NURSE

16. Strengths • Good collaboration – nurse/client/doctors/services • Focuses on prevention • Highlights health promotion • Treatment becomes an integral part of daily life for our client

17. Weaknesses • 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

18. Optimum Example

19. 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?

20. 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

21. 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

22. Examples of Outcomes Measurement • Quality Outcomes • Cost Outcomes • Comparison studies to show contrast • Measuring the complexity of needs

23. 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

24. Bibliography • 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.

25. External 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

26. He aha te mea nui ki te Ao? He tangata, he tangata, he tangata What is the most important treasure on earth? It is people It is people It is people