Case Management and Management Essay

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Nursing care models serve as important foundations for decision making within the care environment. They influence the scope of tasks nurses engage in as well as how nurses relate to other healthcare professionals and patients in the course of care delivery. Though there may be no one-size-fits-all model, the choice of the appropriate model -- obviously depending on factors such as the nature of the organizational setting and the availability of resources -- is crucial. An effective model is important for achieving the desired patient, staff, and organizational outcomes. This paper discusses the use of two care models in the care setting: the case management model and the inter-professional practice model. The aim of the paper is two-fold. First, a description of the case management model as used at a practice setting known to the author is provided. Next, the paper recommends the inter-professional practice model as an alternative model that could be implemented to enhance nursing care quality, safety, as well as staff satisfaction.

The Case Management Model of Care

The case management model is one of the common nursing care models. Dissimilar to most other models, the focus of the model is on patient-centered care, not the nurse-patient relationship (Finkelman, 2016). As the name suggests, the case management model involves assigning each case or a certain number of cases to a specific nurse (registered nurse [RN]). This approach is premised on the assumption that patients have complex health conditions and, hence, require a case manager to help them make use of the healthcare system more effectively. The role of the case manager is to plan, coordinate, evaluate, and advocate for the entire continuum of care required to meet the needs of a given patient (Plas et al., 2012). The case manager may at times work with other healthcare professionals, thereby enhancing inter-professional collaboration (Girard, 1994).

At the author's practice setting, the case management model is prevalent. For most chronic conditions, patients aged 65 and above are assigned to a specific case manager, a registered nurse (RN) in most cases. The RN must have extensive training and knowledge of chronic disease management. The case manager is charged with the responsibility of coordinating every aspect of the care process -- from case-finding and assessment to care planning and case termination. Case-finding is generally the first step of the care process. This stage specifically encompasses determining the patient's risk of admission based on factors such as the patient's previous medical records. Predictive modeling procedures are employed in determining the risk. Efforts and resources are focused on patients with the highest risk. Typically, a high-risk patient has more than six medical conditions. Each case manager is allocated a caseload of roughly 40-50 patients. Once the caseload is built, the patient's clinical background, physical health, socioeconomic needs, and mental health are thoroughly assessed. This enables the case manager to determine the type of interventions required to address the specific needs of the patient.

The identification of interventions is done at the third step, which is to design a personalized care plan based on evidence. An important feature of the hospital's case management approach is that the case manager often works closely with other healthcare professionals in formulating the care plan. More specifically, the case manager works with 4 to 5 physicians as well as other professionals such as general practitioners, pharmacists, laboratory personnel, psychotherapists, and nutritionists.

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The team meets on a regular basis to ensure everyone on the team stays on the same page all the time. The case manager also involves the patient and informal caregivers such as family members in the planning process. For the hospital, collaborative decision making is important for creating a more effective care plan and empowering patients. When patients are involved in the process, they feel acknowledged and valued. The care plan serves as the single reference point for the care administered to the patient under case management.

Once the plan is in place, execution starts. This stage is arguably the most critical. The case manager must effectively coordinate every element of care delivery. This includes medication management, patient education, psychosocial and self-care support, patient monitoring, and communication with patients and their family. Monitoring is a particularly crucial process. Together with the multidisciplinary team, the case manager monitors each patient every two weeks. The case manager coordinates care at not only the hospital setting, but also other settings such as home, rehabilitation clinics, and community settings. An even more important role of the case manager is to advocate for the needs of the patient. In this regard, the case manager ensures the services and equipment identified in the care plan are provided as stated. The case manager also negotiates for aspects such as referrals to specialists, home care, and acquisition of medication. The case manager terminates a case based on one of the following factors: death of the patient, self-discharge, satisfaction that the patient can live independently, and the achievement of an acceptable hospital admission risk on the part of the patient.

Though evidence for the effectiveness of the case management model is mixed, the model has been shown to enhance the experiences of patients and healthcare professionals (Girard, 1994; Plas et al., 2012). A major advantage of the model is that the responsibility of caring for a certain patient or caseload is assigned to a specific individual or team. This enhances accountability. In other words, in the event of mishaps or inefficiencies, a certain individual or team can be easily held to account. Additionally, caseloads are thoroughly built to ensure patients receive care and interventions that resonate with their specific needs. In other words, patients receive individualized care. The case management model also enhances patient outcomes by ensuring a single point of access, fostering care continuity, and empowering patients to have control over their own condition. These advantages translate to positive patient outcomes such as reduced hospitalization, decreased risk of readmission, and patient satisfaction. The case management model is beneficial for not only patients, but also care providers and the organization as a whole. Indeed, the model has been shown to positively affect staff satisfaction (Girard, 1994). For the organization, chronic care delivery costs are minimized as the fragmentation of care is minimized.

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