Professional Case Management最新文献

{"title":"The Commission for Case Manager Certification ® Becomes the Commission™.","authors":"Lynn S Muller","doi":"10.1097/NCM.0000000000000879","DOIUrl":"10.1097/NCM.0000000000000879","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"189-190"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844318","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":"Methodology for Expansion of the SMART Charitable Care Formulary to Enhance Medication Access at Discharge.","authors":"Shay Roth, Dannielle Brown, Erin VanMeter, Robert Green, Rosalyn Stewart, Meghan Swarthout, Lisa Lagana, Caitlin Dowd-Green","doi":"10.1097/NCM.0000000000000881","DOIUrl":"10.1097/NCM.0000000000000881","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>Medication adherence leads to improved health outcomes, significant decreases in health care costs, and reduced preventable rehospitalizations, but can be challenging for uninsured or underinsured patients facing financial barriers to medication access. Pharmacist interventions during hospital admission can ensure patients receive clinically optimized and financially sustainable medications at discharge. The purpose of this project is to expand one of the academic medical center's charitable care programs, the SMART (Streamlined Medication Access for high Risk patienTs) Formulary, which provides medication access to uninsured or underinsured patients in the ambulatory setting.</p><p><strong>Primary practice settings: </strong>This manuscript will describe the process and methods for a pilot expanding the Formulary to inpatients discharging from an internal medicine floor.</p><p><strong>Findings/conclusions: </strong>After obtaining approval from the institutional Department of Care Coordination, the SMART team identified an appropriate internal medicine service and an appropriate time frame to pilot this intervention. The process for identifying patients, appropriate interventions, and communication methods were developed by a pharmacy resident with the oversight of the SMART Team and Care Coordination leadership. Case management and social workers on the medicine floor were oriented to the process and alerted how to contact the team via secure chat in the electronic medical record. During the study period, the SMART team would be alerted prior to discharge if a patient needed assistance with medication access. The SMART Team would then provide recommendations for sustainable medication coverage options prior to discharge. Outcomes were selected to characterize the effort and type of interventions, as well as the financial impact of the service on the medical center. Collected data included patient demographics, medication details, health care utilization (emergency department visits and hospitalizations), time spent pursuing medication access, and which medication access activities were completed prior to discharge. The SMART Team will compare the financial and health care utilization outcomes for the intervention group with a comparator group/benchmark which consisted of a historical cohort of patients discharged from the medicine service during the same period the previous year. This manuscript describes the framework for a service to provide prospective and retrospective pharmacist support for medication acquisition at discharge. Expansion of clinical pharmacist services to ensure charitable medication access for patients at hospital discharge requires input from several stakeholders and communication with provider teams, nurses, case managers, and social workers. This pilot is anticipated to improve sustainable access to evidenced-based medications, enhance the efficiency of charitable care funds, and ","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437477","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":"Ethical Issues and Approaches in Care Management for Older Adults: Interviews With Japanese Care Managers.","authors":"Mari Tsuruwaka","doi":"10.1097/NCM.0000000000000885","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000885","url":null,"abstract":"<p><strong>Purpose of study: </strong>The study aims to clarify the characteristics of and approaches to the ethical issues faced by care managers and to obtain suggestions for ethical care management through interviews with 16 care managers responsible for care management for older adults in Japan.</p><p><strong>Primary practice settings: </strong>The subjects of this study were care managers responsible for care management of older adults in Japan, with at least 3 years of experience working at home care support offices or long-term care welfare facilities.</p><p><strong>Methodology and sample: </strong>The research method was a qualitative study with a descriptive approach using semi-structured interviews, and a content analysis was conducted.</p><p><strong>Results: </strong>Four categories of ethical issues were extracted: those related to the care plan, those occurring when collaborating with other professionals, those occurring within the organization, and those occurring within the system. There were three categories of approaches to ethical issues: continue to be involved to the satisfaction of the client, continue to share and negotiate issues with other professionals, and collaborate for the best interests of older adults.</p><p><strong>Implications for case management practice: </strong>The core role of care managers is not being sufficiently fulfilled, such as care plans that prioritize the intention of the family or the interests of the care manager's own organization over respect for the autonomy and advocacy of older adults and a discrepancy between care management and social work. The two key implications for case management are that the very foundation for realizing person-centered case management lies in considering ethics, and that ethical issues must be addressed as organizational challenges.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260045","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":"Adjusting to Weather-Related Health Risks: A Personal Reflection.","authors":"Ed Quick","doi":"10.1097/NCM.0000000000000856","DOIUrl":"10.1097/NCM.0000000000000856","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"144-145"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745069","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":"Medicare Fraud: This Can Happen to You.","authors":"Lynn S Muller","doi":"10.1097/NCM.0000000000000863","DOIUrl":"10.1097/NCM.0000000000000863","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"146-148"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041751","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":"The Power of PASSION in Professional Case Management Practice.","authors":"Janet Coulter","doi":"10.1097/NCM.0000000000000867","DOIUrl":"10.1097/NCM.0000000000000867","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"138-139"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100964","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":"Quality Measures for Public Reporting and Payment Incentives: Important Information for the Case Manager's Toolkit.","authors":"Gerri Lamb","doi":"10.1097/NCM.0000000000000866","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000866","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"31 3","pages":"140-143"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505175","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":"Why Case Management?","authors":"Lynn S Muller","doi":"10.1097/NCM.0000000000000864","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000864","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"31 3","pages":"149-150"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505212","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":"Addressing Weather-Related Physical and Mental Health Issues: An Eco-Case Management Approach.","authors":"Vivian Campagna, Lorna Lee-Riley, Annette Watson","doi":"10.1097/NCM.0000000000000857","DOIUrl":"10.1097/NCM.0000000000000857","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this article is to enhance a person-centered approach in case management, disability management, and allied disciplines by taking into account the environmental factors affecting people's physical, mental, and emotional health. Drawing from recent research, as well as the example of health support for agriculture producers and workers, the article underscores the weather-related risks that impact people because of where and how they live and work.</p><p><strong>Primary practice settings: </strong>The article addresses professional case managers and allied professionals such as disability management specialists in a variety of settings, including acute care, subacute/rehabilitation, workers' compensation, occupational health and safety, primary care, and community-based care.</p><p><strong>Implications for case management: </strong>In response to evidence of the rising health risks from weather-related events, professional case managers should expand how they assess individuals (known as \"patients\" in some settings) to identify their existing and potential risk factors, including where people live and work and the weather-related risks that may be present in those environments. A case management assessment of an individual's weather-related health risks could not only inform a particular treatment episode but also help avoid preventable setbacks and recurrence of illnesses. If those risks are not addressed, they could lead to costly emergency department visits and/or hospitalization.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"130-137"},"PeriodicalIF":0.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745057","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":"Assessing Health Literacy in Patients With Heart Failure and Potential Impact on Readmissions: A Quality Improvement Project.","authors":"Lauren R Cooke, Jennifer Sipe, Janice M Beitz","doi":"10.1097/NCM.0000000000000861","DOIUrl":"10.1097/NCM.0000000000000861","url":null,"abstract":"<p><strong>Purpose of study: </strong>This quality improvement project was designed to close a gap in capturing health literacy in adult patients with heart failure discharged from a hospital system. An opportunity existed to investigate if health literacy levels contribute to individuals' social factors and overall health. A priority focus was evident across healthcare organizations to address the social determinants of health (SDOH) for the populations served. Throughout the literature, limited health literacy is associated with higher hospital readmission rates. Pre-implementation data included 2023 heart failure readmission rate (19.02%) and baseline SDOH screenings (9,500) which noted housing, food insecurities, and transportation as greatest needs. There was no prior data analysis of how social factors may have impacted readmissions.</p><p><strong>Primary practice settings: </strong>Patients with recent hospitalization in Acute Care Hospitals with a known heart failure diagnosis; received health literacy screenings by the Registered Nurse (RN) Transitional Care Managers (TCMs) during their post-hospital discharge follow-up calls.</p><p><strong>Methodology and sample: </strong>Pre-implementation period began in August 2024. Project launched in November 2024 with RN TCMs conducting assessments using the BRIEF (Health Literacy Screening Tool) during post-hospital discharge calls. Additional follow-up calls were required as the intervention for patients with limited literacy during their 30-day post-hospitalization transition period. Data collection occurred from November 2024 through June 2025.</p><p><strong>Results: </strong>The 8-month period included 1,543 high-risk hospital discharges, among them 580 patients with heart failure screened for health literacy; 517 patients had adequate health literacy, 44 had marginal health literacy, and 19 had limited health literacy. The intervention of additional follow-up calls for patients with limited health literacy achieved statistical significance in reducing readmissions.</p><p><strong>Implications for case management practice: </strong>By implementing the BRIEF screening tool within an existing RN TCM workflow, it allowed for RN TCMs to interview patients with important questions during a vulnerable time for patients - transitioning from hospital to home. Expansion of health literacy assessments is vital for patients with any chronic condition, not just heart failure. RN TCMs identify the necessary interventions needed to support their patients and develop care plans. It is especially important to understand the needs specifically for patients with limited health literacy. Care management plays a pivotal role in patient advocacy by providing education and coordinating directly with providers to support patients' journey to better health.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"123-129"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960529","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}