This classic resource offers complete coverage of nursing case management - from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success.
Includes numerous proven case management models currently being used in institutions across the country
Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program
Offers detailed guidance for planning, implementing, and evaluating a case management program
Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships
Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues
Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice
Presents acute care and community based models of case management
Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care
Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level
Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities
New to this Edition
A new chapter, Telehealth Applications for Case Management, introduces the concept of telehealth; provides examples of telehealth usage in women's health, chronic disease management, and mental health; and summarizes the evidence that supports telehealth and identifies existing issues and challenges.
Case Management: Life at the Intersection of Margin and Mission, is a new chapter that highlights strategies case managers and others can use to optimize their organizations' financial outcomes while simultaneously improving clinical outcomes for their patients. It emphasizes the work of case managers in the financial arena of health care, including revenue cycle management.
A new chapter, Maximizing Reimbursement through Accurate Documentation and Coding, provides tips and strategies on maximizing reimbursement by designing and implementing programs focused on improving the physician's documentation.
Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study is a new chapter that discusses strategy maps and balanced scorecards and their role in transforming an organization's mission and strategy into a management system and a comprehensive set of performance measures.
Features updated information on HIPPA regulation (Health Insurance Portability and Accountability Act), patient safety and confidentiality issues, case management for Medicare patients, Medicare legislation, and utilization management.
1. Evolution of Nursing Case Management in a Changing Health Care System 2. Historical Perspective of Nursing Care Delivery Models within the Hospital Setting 3. Historical Development of Case Management
UNIT II: CONTEMPORARY MODELS OF CASE MANAGEMENT
4. Dimensions of Nursing Case Management 5. Two Strategies for Managing Care: Care Management and Case Management 6. Disease Management: Applying Systems Thinking to Quality Patient Care Delivery
UNIT III: CONTEMPORARY MODELS OF CASE MANAGEMENT- WITHIN-THE-WALLS CASE MANAGEMENT
7. Within-the-Walls Case Management: An Acute Care-Based Nursing Case Management Model 8. Collaborative Models of Case Management 9. Case Management: A Process Not a Person 10. The University of Colorado Hospital Psychiatric Service Health Case Management Model: An Innovative Approach to Client-Centered Care
UNIT IV: CONTEMPORARY CASE MANAGEMENT: BEYOND-THE-WALLS CASE MANAGEMENT
11. Beyond-the-Walls Case Management 12. Outcomes of Community-Based Nurse Case Management Programs 13. Integrated Case Management Model 14. A Faculty Case Management Practice Based in a College of Nursing 15. A Model of Emergency Department Case Management: Developing Strategies and Outcomes
UNIT V: ADDRESSING HEALTH CARE DELIVERY THROUGH CASE MANAGEMENT: PUBLIC POLICY IMPLICATIONS
16. Patient Demographic Affecting Health Care 17. The Business of Health Care and the Prospective Payment System 18. Patient Mix and Cost Related to Length of Hospital Stay 19. Case Management Legislation: National Attempts to Provide Efficient Health Care 20. The Managed Care Market: Nurse Case Management as a Strategy for Success 21. Financing Health Care in the U.S.: Economic and Policy Implications 22. Public Policy, and Community-Based Case Management: The Nurse-Family Partnership
UNIT VI: THE PLANNING PROCESS: DEVELOPING COLLABORATIVE RELATIONSHIPS
23. Assessing the System and Creating an Environment for Change 24. Case Management Education: Preparing for Successful Implementation 25. The Competency Outcomes and Performance Assessment Model Applied to Nursing Case Management Systems 26. The Role of the Nurse Case Manager 27. Credentialing for Case Management: Licensure, Certification, Certificate Programs, and Accreditation 28. Facilitating Educational and Career Mobility: Online Case Management
UNIV VII: IMPLEMENTATION: TAKING A SYSTEMS PROCESS APPROACH
29. The Cast of Characters 30. Variations Within Clinical Settings 31. Brainstorming: Development of the Multidisciplinary Action Plan (MAP) 32. Interdisciplinary Care Planning and Documentation using NIC and NOC 33. Ethical Issues in Case Management 34. Case Management and Information Technology 35. NEW! Telehealth Applications for Case Management 36. Compliance and Regulation
UNIT VIII: EVALUATION, OUTCOMES MEASUREMENT, AND RESEARCH: IMPORTANT COMPONENTS OF DECISION MAKING
37. Key Functions and Direct Outcomes of Case Management 38. NEW! Case Management: Life at the Intersection of Margin and Mission 39. NEW! Maximizing Reimbursement through Accurate Documentation and Coding 40. The Data-Driven Health Care Environment: Methods of Gathering and Presenting Relevant Data About Health Care Systems 41. The Importance of Research in the Evaluation Process 42. Documentation of Quality Care 43. The Link Between Continuous Quality Improvement and Case Management 44. Job Satisfaction 45. Nurse Case Manager Job Characteristics and Effects on Well-Being 46. Measuring Cost-Effectiveness 47. Case Management Evaluation: The Use of the Cost-Effectiveness Analysis Method 48. Linking the Restructuring of Nursing Care With Outcomes: Conceptualizing the Effects of Nursing Case Management using Measurement and Logic Models 49. An Overview of Assessing Health Through Quality of Life Indicators 50. NEW! Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study 51. Outcomes Effectiveness and Evidence-Based Practice 52. The Carondelet Community-Based Nurse Case Management Program: Yesterday, Today & Tomorrow
By Elaine Cohen, EdD, RN, FAAN, Director of Case Management, University of Colorado Hospital, University of Colorado Health Sciences Center, Denver, CO; and Toni G. Cesta, PhD, RN, FAAN, Director of Case Management, Saint Vincent Catholic Medical Centers of New York, Manhattan Region, and Principal, Case Manager Solutions, LLC, Tucson, Arizona