+1(978)310-4246 credencewriters@gmail.com
  

Discussion Question

Read
Chapter 25 Power Point presentation (Case Management):

1. Identify Case Management Roles and explain 5 Roles of the Case Manager.

2. Describe the Essential Skills for Case Managers.

Chapter 25
Case Management
Copyright © 2020 by Elsevier Inc. All rights reserved.
Objectives
(1 of 2)
Define continuity of care, care management,
case management, care coordination,
population health management, transitional
care, integrated care, social determinants of
health, and advocacy.
 Describe the scope of practice, roles, and
functions of a case manager.
 Compare and contrast the nursing process with
processes of case management and advocacy.

Copyright © 2020 by Elsevier Inc. All rights reserved.
2
Objectives
(2 of 2)
Identify methods to manage conflict, as well as
the process of achieving collaboration.
 Define and explain the legal and ethical issues
confronting case managers.

Copyright © 2020 by Elsevier Inc. All rights reserved.
3
Definitions
Population management
 Social mandate
 Care management
 Utilization management
 Critical pathways
 Disease management
 Demand management

Copyright © 2020 by Elsevier Inc. All rights reserved.
4
Concepts of Case Management
Case management and the nursing process
 Characteristics and roles
 Knowledge and skill requisites
 Tools of case managers
 Historical evidence
 Contemporary evidence

Copyright © 2020 by Elsevier Inc. All rights reserved.
5
Case Management and the Nursing
Process
Assessment
 Diagnosis
 Planning for outcomes
 Implementation
 Evaluation

Copyright © 2020 by Elsevier Inc. All rights reserved.
6
Case Management Roles
Broker
 Consultant
 Coordinator
 Educator
 Facilitator
 Liaison
 Mentor
 Monitor/reporter

Negotiator
 Client advocate
 Researcher
 Standardization
monitor
 Systems allocator

Copyright © 2020 by Elsevier Inc. All rights reserved.
7
Factors That Demand Case
Management Attention
Copyright © 2020 by Elsevier Inc. All rights reserved.
8
Knowledge and Skill Requisites









Standards of practice for case
management
Evidence-based practice
guidelines
Knowledge of the health care
financial environment
Clinical knowledge, skill, and
maturity
Care resources
Transition planning
Management skills
Teaching, counseling, and
education skills
Program evaluation and research








Performance improvement
techniques
Peer consultation and evaluation
Requirements of eligibility and
benefit parameters by third-party
payers
Legal and ethical issues
Information management systems
Health care legislation/policy
Technical information skills
Outcomes management and
applied research
Copyright © 2020 by Elsevier Inc. All rights reserved.
9
Tools of Case Managers
(1 of 2)

Six “rights” of case management
➢ Right care
➢ Right time
➢ Right provider
➢ Right setting
➢ Right price/value
➢ Right outcomes
Copyright © 2020 by Elsevier Inc. All rights reserved.
10
Tools of Case Managers
(2 of 2)

Three tools
➢ Case management plans
• Standards of client care and nursing practice
• Clinical guidelines
• Evidence-based practices
• Critical path development gave way to care maps
➢ Disease management
• Focus: the natural progression of a disease in high-risk populations
➢ Life care planning
• Needs of a client for catastrophic or chronic disease over a life span

Technology driven
Copyright © 2020 by Elsevier Inc. All rights reserved.
11
Evidence-Based Examples of
Case Management

Historical evidence
➢ Taylor’s three models
• Client focused
• System focused
• Social service

Contemporary evidence
➢ Model of intensive case management (ICM)
• Kolbasovshy (2009)
• Reduced readmissions
• CARE ONE program: reduced emergency room (ER) visits
• 2012 Study: decreased acute outpatient and inpatient admissions
Copyright © 2020 by Elsevier Inc. All rights reserved.
12
Quick Recall
(1 of 2)
Which model demonstrated a consistent reduction
in ER visits, readmissions, and acute outpatient
and inpatient admissions in multiple studies?
A. Social service
B. Client-focused
C. System-focused
D. Intensive case management
Copyright © 2020 by Elsevier Inc. All rights reserved.
13
Quick Recall
(2 of 2)
Answer is D.
Intensive case management
Copyright © 2020 by Elsevier Inc. All rights reserved.
14
How’d You Do?

Model of intensive case management (ICM)
➢ Reduced readmissions
➢ Reduced ER visits
➢ Reduced acute outpatient and inpatient admissions
Copyright © 2020 by Elsevier Inc. All rights reserved.
15
Essential Skills for Case Managers
Advocacy
 Conflict management
 Collaboration

Copyright © 2020 by Elsevier Inc. All rights reserved.
16
Advocacy
(1 of 2)

The advocacy role aims to achieve patient
engagement.
➢ By helping patients become invested in their health
and care through programs that provide information
and tools to empower them to take control and
evaluate their care
Copyright © 2020 by Elsevier Inc. All rights reserved.
17
Advocacy
(2 of 2)

Process of advocacy
➢ Promoting self-determination in clients
➢ Informing:
• Amplifying
• Clarifying
• Verifying
➢ Supporting
➢ Affirming
• Illuminating values
Copyright © 2020 by Elsevier Inc. All rights reserved.
18
Allocation and Advocacy

Allocation roles in nursing
➢ Triage
➢ Gatekeeping
➢ Rationing

Systems-level demands
➢ Budget decisions
➢ Staffing assignments

Clinical level demands
➢ Implementing treatment protocols

Advocacy can conflict with allocation.
➢ Limited resources contribute to this conflict.
Copyright © 2020 by Elsevier Inc. All rights reserved.
19
Conflict Management

Negotiation outcomes
➢ Distributive outcomes
• One party gains
➢ Integrative outcomes
• Mutual advantages override individual gains

Negotiation stages
➢ Prenegotiating
➢ Negotiating
➢ Aftermath
Copyright © 2020 by Elsevier Inc. All rights reserved.
20
Negotiation Phases
Establish issues and agenda.
 Advance demands and uncover interests.
 Bargain and discover new options.
 Work out an agreement.

Copyright © 2020 by Elsevier Inc. All rights reserved.
21
Collaboration
(1 of 2)
Communication is essential but not sufficient.
 Joint decision making valued

➢ However, one member should be accountable.

Handling competing expectations
Copyright © 2020 by Elsevier Inc. All rights reserved.
22
Collaboration
(2 of 2)

Goal: to amplify,
clarify, and verify all
team members’ points
of view
Copyright © 2020 by Elsevier Inc. All rights reserved.
23
Issues in Case Management
Legal issues
 Ethical issues

Copyright © 2020 by Elsevier Inc. All rights reserved.
24
Legal Issues
Liability for managing care
 Negligent referrals
 Experimental treatment and technology
 Confidentiality/security
 Fraud and abuse

Copyright © 2020 by Elsevier Inc. All rights reserved.
25
Ethical Issues
Autonomy
 Beneficence
 Fidelity
 Justice
 Nonmaleficence
 Veracity

Copyright © 2020 by Elsevier Inc. All rights reserved.
26
Chapter 25
Case Management
Copyright © 2020 by Elsevier Inc. All rights reserved.
Objectives
(1 of 2)
Define continuity of care, care management,
case management, care coordination,
population health management, transitional
care, integrated care, social determinants of
health, and advocacy.
 Describe the scope of practice, roles, and
functions of a case manager.
 Compare and contrast the nursing process with
processes of case management and advocacy.

Copyright © 2020 by Elsevier Inc. All rights reserved.
2
Objectives
(2 of 2)
Identify methods to manage conflict, as well as
the process of achieving collaboration.
 Define and explain the legal and ethical issues
confronting case managers.

Copyright © 2020 by Elsevier Inc. All rights reserved.
3
Definitions
Population management
 Social mandate
 Care management
 Utilization management
 Critical pathways
 Disease management
 Demand management

Copyright © 2020 by Elsevier Inc. All rights reserved.
4
Concepts of Case Management
Case management and the nursing process
 Characteristics and roles
 Knowledge and skill requisites
 Tools of case managers
 Historical evidence
 Contemporary evidence

Copyright © 2020 by Elsevier Inc. All rights reserved.
5
Case Management and the Nursing
Process
Assessment
 Diagnosis
 Planning for outcomes
 Implementation
 Evaluation

Copyright © 2020 by Elsevier Inc. All rights reserved.
6
Case Management Roles
Broker
 Consultant
 Coordinator
 Educator
 Facilitator
 Liaison
 Mentor
 Monitor/reporter

Negotiator
 Client advocate
 Researcher
 Standardization
monitor
 Systems allocator

Copyright © 2020 by Elsevier Inc. All rights reserved.
7
Factors That Demand Case
Management Attention
Copyright © 2020 by Elsevier Inc. All rights reserved.
8
Knowledge and Skill Requisites









Standards of practice for case
management
Evidence-based practice
guidelines
Knowledge of the health care
financial environment
Clinical knowledge, skill, and
maturity
Care resources
Transition planning
Management skills
Teaching, counseling, and
education skills
Program evaluation and research








Performance improvement
techniques
Peer consultation and evaluation
Requirements of eligibility and
benefit parameters by third-party
payers
Legal and ethical issues
Information management systems
Health care legislation/policy
Technical information skills
Outcomes management and
applied research
Copyright © 2020 by Elsevier Inc. All rights reserved.
9
Tools of Case Managers
(1 of 2)

Six “rights” of case management
➢ Right care
➢ Right time
➢ Right provider
➢ Right setting
➢ Right price/value
➢ Right outcomes
Copyright © 2020 by Elsevier Inc. All rights reserved.
10
Tools of Case Managers
(2 of 2)

Three tools
➢ Case management plans
• Standards of client care and nursing practice
• Clinical guidelines
• Evidence-based practices
• Critical path development gave way to care maps
➢ Disease management
• Focus: the natural progression of a disease in high-risk populations
➢ Life care planning
• Needs of a client for catastrophic or chronic disease over a life span

Technology driven
Copyright © 2020 by Elsevier Inc. All rights reserved.
11
Evidence-Based Examples of
Case Management

Historical evidence
➢ Taylor’s three models
• Client focused
• System focused
• Social service

Contemporary evidence
➢ Model of intensive case management (ICM)
• Kolbasovshy (2009)
• Reduced readmissions
• CARE ONE program: reduced emergency room (ER) visits
• 2012 Study: decreased acute outpatient and inpatient admissions
Copyright © 2020 by Elsevier Inc. All rights reserved.
12
Quick Recall
(1 of 2)
Which model demonstrated a consistent reduction
in ER visits, readmissions, and acute outpatient
and inpatient admissions in multiple studies?
A. Social service
B. Client-focused
C. System-focused
D. Intensive case management
Copyright © 2020 by Elsevier Inc. All rights reserved.
13
Quick Recall
(2 of 2)
Answer is D.
Intensive case management
Copyright © 2020 by Elsevier Inc. All rights reserved.
14
How’d You Do?

Model of intensive case management (ICM)
➢ Reduced readmissions
➢ Reduced ER visits
➢ Reduced acute outpatient and inpatient admissions
Copyright © 2020 by Elsevier Inc. All rights reserved.
15
Essential Skills for Case Managers
Advocacy
 Conflict management
 Collaboration

Copyright © 2020 by Elsevier Inc. All rights reserved.
16
Advocacy
(1 of 2)

The advocacy role aims to achieve patient
engagement.
➢ By helping patients become invested in their health
and care through programs that provide information
and tools to empower them to take control and
evaluate their care
Copyright © 2020 by Elsevier Inc. All rights reserved.
17
Advocacy
(2 of 2)

Process of advocacy
➢ Promoting self-determination in clients
➢ Informing:
• Amplifying
• Clarifying
• Verifying
➢ Supporting
➢ Affirming
• Illuminating values
Copyright © 2020 by Elsevier Inc. All rights reserved.
18
Allocation and Advocacy

Allocation roles in nursing
➢ Triage
➢ Gatekeeping
➢ Rationing

Systems-level demands
➢ Budget decisions
➢ Staffing assignments

Clinical level demands
➢ Implementing treatment protocols

Advocacy can conflict with allocation.
➢ Limited resources contribute to this conflict.
Copyright © 2020 by Elsevier Inc. All rights reserved.
19
Conflict Management

Negotiation outcomes
➢ Distributive outcomes
• One party gains
➢ Integrative outcomes
• Mutual advantages override individual gains

Negotiation stages
➢ Prenegotiating
➢ Negotiating
➢ Aftermath
Copyright © 2020 by Elsevier Inc. All rights reserved.
20
Negotiation Phases
Establish issues and agenda.
 Advance demands and uncover interests.
 Bargain and discover new options.
 Work out an agreement.

Copyright © 2020 by Elsevier Inc. All rights reserved.
21
Collaboration
(1 of 2)
Communication is essential but not sufficient.
 Joint decision making valued

➢ However, one member should be accountable.

Handling competing expectations
Copyright © 2020 by Elsevier Inc. All rights reserved.
22
Collaboration
(2 of 2)

Goal: to amplify,
clarify, and verify all
team members’ points
of view
Copyright © 2020 by Elsevier Inc. All rights reserved.
23
Issues in Case Management
Legal issues
 Ethical issues

Copyright © 2020 by Elsevier Inc. All rights reserved.
24
Legal Issues
Liability for managing care
 Negligent referrals
 Experimental treatment and technology
 Confidentiality/security
 Fraud and abuse

Copyright © 2020 by Elsevier Inc. All rights reserved.
25
Ethical Issues
Autonomy
 Beneficence
 Fidelity
 Justice
 Nonmaleficence
 Veracity

Copyright © 2020 by Elsevier Inc. All rights reserved.
26

Purchase answer to see full
attachment

  
error: Content is protected !!