Professional Case Management最新文献

{"title":"Development of an Emergency Department Case Management Case-Finding Tool.","authors":"David Gallagher, Barbara Bentley, Ashley Barry, Amy Fraccola, Rosimeire Santos, Adam Glenn, James Howard, Aparna Kamath, Katie Flanagan","doi":"10.1097/NCM.0000000000000699","DOIUrl":"10.1097/NCM.0000000000000699","url":null,"abstract":"<p><strong>Purpose of study: </strong>Identifying emergency department (ED) patients who are at high risk for return visits is an important goal for case management to improve patient care. This quality improvement study describes the development and evaluation of the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based \"case-finding\" system, and its ability to identify these high-risk patients. In addition, the authors present data about its acceptability among emergency department case managers (ED CMs).</p><p><strong>Primary practice settings: </strong>Emergency departments with case management availability and staffing.</p><p><strong>Methodology and sample: </strong>A retrospective analysis at Duke University Hospital ED compared patient data pre- and postimplementation of the EDCMPS. The tool was developed using the LEAN and Plan-Do-Study-Act (PDSA) quality improvement methodologies, with ED CM participation. ED return and hospitalization rates within 7 and 30 days between both methods were compared, and a survey evaluated CM satisfaction with the EDCMPS.</p><p><strong>Results: </strong>The 2-month preintervention period (July 1, 2022, to August 31, 2022) included 8,677 patients discharged from the ED, with 897 patients (10.3%) identified as at high risk for return based on the previous manual methodology. In the 3-month postintervention period (September 1, 2022, to November 30, 2022), there were 13,566 patients discharged, with 692 patients (5.1%) identified as at high risk for return using the EDCMPS. The EDCMPS outperformed the manual method, yielding a significantly higher odds ratio (OR) for 7- and 30-day ED return or hospitalization (e.g., 30-day any return OR = 4.21 vs. 1.69). The survey showed broad ED CM agreement on the tool's superior performance, especially in organizing outpatient resources and referring to support programs. However, challenges in securing primary care follow-up, housing, and health insurance applications were identified. The tool's collaborative development approach ensured its fit to ED CM needs, contributing to its success.</p><p><strong>Implications for case management practice: </strong>The EDCMPS showcases promise in enhancing ED CM efficiency, with strong frontline staff endorsement. It pinpoints areas needing focus for patient support and has the potential to reduce ED revisits and therefore health care utilization. Its methodology offers insights for similar future implementations in health care institutions.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"102-110"},"PeriodicalIF":1.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048163","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":"Celebrating Small Miracles-Because We Can't Change the World.","authors":"Vivian Campagna","doi":"10.1097/NCM.0000000000000710","DOIUrl":"10.1097/NCM.0000000000000710","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"78-80"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514034","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":"Multistate Case Management: Confusion Persists.","authors":"Lynn S Muller","doi":"10.1097/NCM.0000000000000709","DOIUrl":"10.1097/NCM.0000000000000709","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"74-77"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514043","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":"SDOH and Immigration Status: Offering Advocacy and Adhering to Ethical Practice Across the Care Continuum.","authors":"","doi":"10.1097/NCM.0000000000000713","DOIUrl":"10.1097/NCM.0000000000000713","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"E5-E6"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514049","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":"Effective Care Transitions: Reducing Readmissions to Improve Patient Care and Outcomes.","authors":"Tara Kinard, Jill Brennan-Cook, Sara Johnson, Andrea Long, John Yeatts, David Halpern","doi":"10.1097/NCM.0000000000000687","DOIUrl":"10.1097/NCM.0000000000000687","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>Care transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and payers recognize that care transition interventions are necessary to reduce unnecessary cost and utilization and improve patient outcomes following a hospitalization. Multiple care transition models exist, with varying degrees of intensity and success. This article describes a quality improvement project for a care transition model that incorporates key elements from the American Case Management Association's Transitions of Care Standards and the Transitional Care Management services as outlined by the Centers for Medicare & Medicaid Services.</p><p><strong>Primary practice setting: </strong>A collaboratively developed care transition model was implemented between a health system population health management office and a primary care organization.</p><p><strong>Findings/conclusions: </strong>An effective care transitions model is stronger with collaboration among core members of a patient's care team, including a nurse care manager and a primary care provider. Ongoing quality improvement is necessary to gain efficiencies and effectiveness of such a model.</p><p><strong>Implications for case management practice: </strong>Care managers are integral in coordinating effective transitions. Care management practice includes transition of care standards that are associated with improved outcomes for patients at high risk for readmission. Interventions inclusive of medication reconciliation, identification and addressing of health-related social needs, review of discharge instructions, and coordinated follow-up are important factors that impact patient outcomes. Patients and their health system care teams benefit from the role of a care manager when there is a collaborative, coordinated, and timely approach to hospital follow-up.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"54-62"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452819","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":"Effective Care Transitions: Reducing Readmissions to Improve Patient Care and Outcomes.","authors":"","doi":"10.1097/NCM.0000000000000714","DOIUrl":"10.1097/NCM.0000000000000714","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"E7-E8"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514040","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 Occupational Hazard of Being a Patient Who Is a Case Manager.","authors":"Connie Sunderhaus","doi":"10.1097/NCM.0000000000000708","DOIUrl":"10.1097/NCM.0000000000000708","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"72-73"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514057","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":"Training Home Care Workers Reduces Emergency Room Service Utilization.","authors":"Susan A Chapman, Melinda T Neri, Robert J Newcomer","doi":"10.1097/NCM.0000000000000711","DOIUrl":"10.1097/NCM.0000000000000711","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 2","pages":"81-87"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139514063","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":"Growth of Remote Therapeutic Monitoring Lands New Opportunities for Case Management.","authors":"Kathleen Moreo, Tamar Sapir","doi":"10.1097/NCM.0000000000000688","DOIUrl":"10.1097/NCM.0000000000000688","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>An increase in the use of remote therapeutic monitoring (RTM) has been spurred by nationwide factors including the COVID-19 pandemic, authorized reimbursement of RTM by the Centers for Medicare & Medicaid Services, and more frequent use of big data analytics in health care delivery. This article discusses the use of RTM by care teams at the point of care and explores the role of the case manager in RTM to address patients' unmet needs.</p><p><strong>Primary practice settings: </strong>Although RTM may be utilized across inpatient and outpatient levels of care, this article focuses on outpatient care such as community clinics, provider groups, and home health care.</p><p><strong>Findings/conclusions: </strong>When implemented along with care management interventions, RTM applications have the potential to improve patient adherence, enhance communication between patients and their providers, streamline resource allocation, and address social determinants of health impacting patient care and outcomes.</p><p><strong>Implications for case management practice: </strong>RTM reimbursement models are rapidly evolving, utilizing real-world and patient-reported data to identify and initiate timely, individualized solutions that meet the holistic needs of each patient. Use of an RTM system allows the case manager to build rapport with the patient while quickly identifying care gaps and delivering appropriate interventions that can maximize patient outcomes. RTM can drive savings and bring revenue to the system or practice while providing salient documentation of social determinants of health that can be addressed with validation of proven care coordination interventions.</p>","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":" ","pages":"63-69"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452820","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":"Case Managers From Around the World Come Together to Discover Solutions and Drive Change.","authors":"Colleen M Morley","doi":"10.1097/NCM.0000000000000693","DOIUrl":"10.1097/NCM.0000000000000693","url":null,"abstract":"","PeriodicalId":45015,"journal":{"name":"Professional Case Management","volume":"29 1","pages":"30-31"},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177547","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}