Professional Case Management最新文献

{"title":"Improving Health Care Proxy Documentation for Patients With Cognitive Impairment in an Acute Care Setting: A Quality Improvement Project.","authors":"Fiona S Koshy, Patricia A MacCulloch","doi":"10.1097/NCM.0000000000000826","DOIUrl":"10.1097/NCM.0000000000000826","url":null,"abstract":"<p><strong>Purpose: </strong>Advanced care planning supports discussions about patients' preferences for end-of-life care, frequently resulting in the completion of health care proxy documentation (HCP). This quality improvement project aimed to increase HCP documentation rates for hospitalized patients with cognitive impairment, including those diagnosed with dementia and delirium.</p><p><strong>Primary practice setting: </strong>This project was implemented at a 216-bed acute care, community-based teaching hospital in the northeastern United States.</p><p><strong>Methodology and sample: </strong>The intervention targeted case managers and nursing staff in medical-surgical and stepdown units. Case managers completed an asynchronous educational module on revised workflows for identifying and documenting health care proxy among cognitively impaired patients, followed by a post-training assessment. Concurrently, nursing staff received a practice alert reinforcing their role in verifying patient-designated health care agent upon admission. Program evaluation included demographic data, staff feedback, and aggregate chart reviews to measure changes in documentation rates and process adherence.</p><p><strong>Results: </strong>HCP documentation for hospitalized patients with cognitive impairment increased from an average of 62% to an average of 75.44% over the 12-week implementation period.</p><p><strong>Implications for case management practice: </strong>A structured, case manager-led workflow significantly improved the documentation of health care proxies for patients with cognitive impairment. Future initiatives should integrate nurse-led education on HCP verification and promote interdisciplinary collaboration to enhance advance care planning practices across care teams.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"4-14"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800497","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 Research Is Important.","authors":"Lisa Parker-Williams","doi":"10.1097/NCM.0000000000000838","DOIUrl":"10.1097/NCM.0000000000000838","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"38-40"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087768","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":"Validation of the Practice Environment Scale-Nursing Work Index for Measuring Hospital Case Management Practice Environment.","authors":"","doi":"10.1097/NCM.0000000000000848","DOIUrl":"10.1097/NCM.0000000000000848","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"31 1","pages":"E2"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606616","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 Health Care Proxy Documentation for Patients With Cognitive Impairment in an Acute Care Setting.","authors":"","doi":"10.1097/NCM.0000000000000847","DOIUrl":"10.1097/NCM.0000000000000847","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"31 1","pages":"E1"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145606572","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":"Utilizing a Nurse Discharge Navigator to Reduce Readmissions for Hospitalized Patients With Sepsis: A Quality Improvement Feasibility Study.","authors":"Marta Pruitt, Abby Matusik, Neelam Patel, Kathryn Kreider","doi":"10.1097/NCM.0000000000000823","DOIUrl":"10.1097/NCM.0000000000000823","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>The purpose of this project was to evaluate the impact of a nurse discharge navigator implementing an education and structured outpatient follow-up program on reducing 30-day readmissions for adult patients with sepsis.</p><p><strong>Primary practice setting: </strong>This project was implemented at an 847-bed academic hospital in the southeastern United States.</p><p><strong>Findings/conclusions: </strong>Patient capture in the study was poor, driven by high rates of cancer diagnoses, comfort-directed care, and frequent discharges to postacute care. Readmission rates for patients receiving the full intervention ( n = 16) were 25% ( n = 4). Overall readmission rates for patients with sepsis in 2024 were 13.3% ( n = 61). The outcomes of this project were influenced by the advanced comorbidities of the participants.</p><p><strong>Implications for case management practice: </strong>Case management of patients with sepsis should be comprehensive. Caregivers should be involved early to initiate education on the disease process, have clear communication with the follow-up team, and involve close, structured follow-up that can be adapted to the postacute care setting. One promising area for improvement of this intervention would be the inclusion of a Hospital at Home program as a transition program to the transition clinic.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"27-34"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691905","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":"Validation of the Practice Environment Scale-Nursing Work Index for Measuring Hospital Case Management Practice Environment.","authors":"Kristen A Berryman, Rula Btoush, Olga F Jarrín","doi":"10.1097/NCM.0000000000000835","DOIUrl":"10.1097/NCM.0000000000000835","url":null,"abstract":"<p><strong>Purpose of study: </strong>The Practice Environment Scale of the Nursing Work Index (PES-NWI) is widely used to measure the practice environment across nursing populations. Case management is a specialty focused on care coordination to meet the clinical and financial goals of medically and socially complex individuals across the care continuum. Despite its importance, limited research exists on the hospital case management practice environment, and no instrument currently measures this concept. This study aimed to adapt and validate the psychometric properties of a hospital case management version of the PES-NWI.</p><p><strong>Primary practice setting: </strong>Acute care hospitals where case managers practice.</p><p><strong>Methodology and sample: </strong>Following expert panel feedback, the PES-NWI was adapted and shortened from 31 to 23 items for use in hospital case management. A convenience sample of 160 hospital case managers across the United States was recruited via social media and professional networks. The psychometric evaluation included assessments of validity (content validity via expert panel review, known-groups construct validity, and factor analysis) and reliability (Cronbach's alpha and item-total correlations).</p><p><strong>Results: </strong>Participants included case managers working in 34 states. Most were female (92%) from the nursing discipline (79%) and social work (21%). Nearly 60% held case management certification, and 40% had over 10 years of experience in the field of case management. Factor analysis revealed a four-factor structure with items cleanly loading between 0.44 and 0.74. The four factors represented Supportive and Participatory Leadership, Staffing and Resource Adequacy, Opportunities for Professional Development, and Fostering Teamwork and Collaboration. The factor structure of the adapted instrument differs from that of the original PES-NWI, indicating a need for further testing. Nevertheless, the adapted instrument demonstrates strong internal consistency (overall Cronbach's alpha of 0.93) and item-to-total correlations from 0.37 to 0.80.</p><p><strong>Implications for case management practice: </strong>The adapted instrument, Practice Environment Scale for Hospital Case Management, the first to measure the hospital case management practice environment, demonstrates adequate reliability and validity. It provides a critical foundation for future research and supports the development of evidence-based strategies to enhance hospital case management practice. Understanding this environment is crucial for advancing workforce development, enhancing professional satisfaction, and maximizing the impact of case management in acute care settings.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"15-26"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Quality of Whole-Person Healthcare Delivery Critical Components of a Sickle Cell Disease Nurse Navigator Role.","authors":"","doi":"10.1097/NCM.0000000000000834","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000834","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 6","pages":"E16"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179327","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":"Motivational Interviewing for Successful Smoking Cessation.","authors":"Rachel Phung, Chaunon Bond, Julie-Kathryn Graham","doi":"10.1097/NCM.0000000000000829","DOIUrl":"10.1097/NCM.0000000000000829","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"283-288"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973379","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":"Impact of AHRQ Re-Engineered Discharge Toolkit on Adult Patient's 30-Day Readmission.","authors":"","doi":"10.1097/NCM.0000000000000833","DOIUrl":"https://doi.org/10.1097/NCM.0000000000000833","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"30 6","pages":"E15"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179308","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 Quality of Whole-Person Healthcare Delivery: Critical Components of a Sickle Cell Disease Nurse Navigator Role.","authors":"Mitchell Knisely, Janet Prvu-Bettger, John J Strouse, Paula Tanabe","doi":"10.1097/NCM.0000000000000806","DOIUrl":"10.1097/NCM.0000000000000806","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>Sickle cell disease (SCD) is a complex genetic hemoglobinopathy which is associated with a severely shortened lifespan; the median age of death remains in the low 50's. Individuals living with SCD have complex medical, psychological, and social needs. The complexity results in difficulty navigating the healthcare system, and often being unaware of existing resources that may assist with addressing unmet social needs. Navigating fragmented healthcare and other support systems, as well as ensuring access to care, is challenging for persons with complex chronic diseases such as those living with SCD. Most healthcare institutions do not use SCD-specific nurse navigation models. The purpose is to describe an evidence-based SCD practice model for nurse navigation to improve the quality of whole-person healthcare delivery.</p><p><strong>Primary practice settings: </strong>Care for individuals with SCD.</p><p><strong>Findings/conclusions: </strong>This disease-focused, nurse navigation model was adapted from effective models and theories. The authors identify and describe nurse navigator competencies, including care coordination, patient education and support, communication, and expertise in SCD care delivery. Each of these competencies is operationalized into core and adaptable intervention components in this model to improve the quality of life and longevity of individuals living with SCD.</p><p><strong>Implications for case management practice: </strong>Nurse navigators are required to understand and manage the care of individuals with complex healthcare needs. The authors identified a comprehensive model that clearly delineates the most effective components of nurse navigation for SCD that can be adopted to a variety of healthcare and community settings to achieve the highest likelihood of meeting whole person healthcare delivery needs. Partnering with community-based organizations, healthcare systems, and government resources is critical.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"251-260"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016997","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}