Professional Case Management最新文献

{"title":"Interprofessional Collaboration as a Best Practice Across the Care Continuum.","authors":"Vivian Campagna, Lorna Lee-Riley","doi":"10.1097/NCM.0000000000000793","DOIUrl":"10.1097/NCM.0000000000000793","url":null,"abstract":"<p><strong>Purpose: </strong>Interprofessional teams are increasingly being recognized as a best practice for enhancing cooperation among multiple disciplines in delivering person-centered care and improving outcomes. Unlike previous models, such as the multidisciplinary team in which each profession or discipline remained largely siloed, with interprofessional teams collaboration occurs across disciplines. For case managers, the interprofessional team concept aligns with the collaborative, professionally diverse nature of the field of practice. As the Commission for Case Manager Certification (CCMC) states: \"The practice of case management is professional and collaborative, occurring in a variety of settings where medical care, mental health care, and social supports are delivered. Services are facilitated by diverse disciplines in conjunction with the care recipient and their support system\" (2024b, CCMC Definition and Philosophy, p.1). Although interprofessional teams may be more familiar in settings such as acute care, this dynamic can be found, formally and informally, across health and human services. Professional case managers who actively participate in interprofessional teams will likely find more opportunities to optimize collaboration and collective decision-making that bring out the best of every profession and discipline.</p><p><strong>Primary practice settings: </strong>Interprofessional teams can be found in multiple care settings including acute care, subacute care, community-based care, palliative/end-of-life and other settings that benefit from a person-centered approach that supports successful transitions of care and improved outcomes.</p><p><strong>Implications for case management practice: </strong>Professional case managers are valued members of interprofessional teams, in that they are typically collaborative, promote open communication, and encourage cooperation among various disciplines. Interprofessional teams, however, may require a shift in thinking away from the former multidisciplinary model, in which case managers often acted as the hub connecting the spokes of each discipline. Within interprofessional teams, the individual is at the center, and every discipline will share leadership based on the individual's needs or the treatment protocol or other intervention needed in the moment. In this way, interprofessional teams become a model for empowering and allowing each discipline to step up and address specific aspects of treatment or other interventions.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"100-106"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Effectiveness of Health Plan-Based Case Management: Erratum.","authors":"Michael B Garrett","doi":"10.1097/NCM.0000000000000804","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000804","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"121"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Texting in Healthcare.","authors":"Lynn S Muller","doi":"10.1097/NCM.0000000000000794","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000794","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"119-121"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Readmissions Using Collaborative Care.","authors":"Melissa Cawley-Chambers","doi":"10.1097/NCM.0000000000000767","DOIUrl":"10.1097/NCM.0000000000000767","url":null,"abstract":"<p><strong>Purpose of initiative: </strong>After noting an elevated chronic obstructive pulmonary disease readmission rate for 2022, the inpatient Nurse Navigator at a rural nonprofit, 116-bed acute care facility in the State of Virginia met with interdisciplinary team (IDT) members to identify improvement efforts to decrease 30-day readmission rates.</p><p><strong>Primary practice setting: </strong>A 116-bed health care facility in Southside Virginia.</p><p><strong>Methodology and sample: </strong>Quality improvement initiative aimed to decrease 30-day penalty readmission rates using a collaborative IDT approach, focusing on patients 65 years or older who are discharged home or to an assisted living facility with a diagnosis of acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, and pneumonia.</p><p><strong>Results: </strong>Compared to the readmission rates obtained in 2022, the 2023 readmission rates among the four diagnoses groups met or were under the disease-specific targets for 2023, supporting the efforts of the collaborative interdisciplinary approach to decrease 30-day readmission rates.</p><p><strong>Implications for case management practice: </strong>Addressing community barriers and social determinants of health at the index admission. Collaborating with IDT members for a safe transition of care. Using the community paramedic program to provide additional resources to a rural community.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"93-99"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024: Celebrating a Year of Excellence and Achievement With CMSA.","authors":"Janet S Coulter","doi":"10.1097/NCM.0000000000000795","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000795","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"107-110"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Gaslighting's Universal Truth.","authors":"Ellen Fink-Samnick","doi":"10.1097/NCM.0000000000000796","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000796","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"111-115"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Readmissions Using Collaborative Care.","authors":"","doi":"10.1097/NCM.0000000000000799","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000799","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"E10"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations to End of Life Care Planning for Patients on High Flow Nasal Cannula.","authors":"Julie Graham, Lindsay Richardson, Laura Maldoon, Jendi Durrant, Christina Kelley","doi":"10.1097/NCM.0000000000000800","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000800","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"122-124"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.","authors":"Jason Lindsey, Teresa Welch","doi":"10.1097/NCM.0000000000000766","DOIUrl":"10.1097/NCM.0000000000000766","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary practice setting: &lt;/strong&gt;The quality improvement project was implemented on two telemetry units at an acute care hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology and sample: &lt;/strong&gt;A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7 days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The evidence-based project was implemented over 7 weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for case management practice: &lt;/strong&gt;Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise t","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"81-92"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.","authors":"","doi":"10.1097/NCM.0000000000000798","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000798","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 3","pages":"E9"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}