Nursing Case Management: From Essentials to Advanced Practice Applications / Edition 4

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Overview

This classic resource offers complete coverage of nursing case management — from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success.

• Includes numerous proven case management models currently being used in institutions across the country

• Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program

• Offers detailed guidance for planning, implementing, and evaluating a case management program

• Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships

• Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues

• Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice

• Presents acute care and community based models of case management

• Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care

• Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level

• Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities

• A new chapter, Telehealth Applications for Case Management, introduces the concept of telehealth; provides examples of telehealth usage in women's health, chronic disease management, and mental health; and summarizes the evidence that supports telehealth and identifies existing issues and challenges.

• Case Management: Life at the Intersection of Margin and Mission, is a new chapter that highlights strategies case managers and others can use to optimize their organizations' financial outcomes while simultaneously improving clinical outcomes for their patients. It emphasizes the work of case managers in the financial arena of health care, including revenue cycle management.

• A new chapter, Maximizing Reimbursement through Accurate Documentation and Coding, provides tips and strategies on maximizing reimbursement by designing and implementing programs focused on improving the physician's documentation.

• Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study is a new chapter that discusses strategy maps and balanced scorecards and their role in transforming an organization's mission and strategy into a management system and a comprehensive set of performance measures.

• Features updated information on HIPPA regulation (Health Insurance Portability and Accountability Act), patient safety and confidentiality issues, case management for Medicare patients, Medicare legislation, and utilization management.

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Product Details

  • ISBN-13: 9780323027656
  • Publisher: Elsevier Health Sciences
  • Publication date: 8/26/2004
  • Edition description: Revised
  • Edition number: 4
  • Pages: 640
  • Sales rank: 697,542
  • Product dimensions: 7.54 (w) x 9.50 (h) x 0.44 (d)

Meet the Author

Director of Case Management, University of Colorado Hospital, University of Colorado Health Sciences Center, Denver, CO

Director of Case Management, Saint Vincent Catholic Medical Centers of New York, Manhattan Region; Principal, Case Manager Solutions, LLC, Tucson, AZ

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Table of Contents

UNIT I: EVOLUTION OF CASE MANAGEMENT

1. Evolution of Nursing Case Management in a Changing Health Care System
2. Historical Perspective of Nursing Care Delivery Models within the Hospital Setting
3. Historical Development of Case Management

UNIT II: CONTEMPORARY MODELS OF CASE MANAGEMENT

4. Dimensions of Nursing Case Management
5. Two Strategies for Managing Care: Care Management and Case Management
6. Disease Management: Applying Systems Thinking to Quality Patient Care Delivery

UNIT III: CONTEMPORARY MODELS OF CASE MANAGEMENT- WITHIN-THE-WALLS CASE MANAGEMENT

7. Within-the-Walls Case Management: An Acute Care-Based Nursing Case Management Model
8. Collaborative Models of Case Management
9. Case Management: A Process Not a Person
10. The University of Colorado Hospital Psychiatric Service Health Case Management Model: An Innovative Approach to Client-Centered Care

UNIT IV: CONTEMPORARY CASE MANAGEMENT: BEYOND-THE-WALLS CASE MANAGEMENT

11. Beyond-the-Walls Case Management
12. Outcomes of Community-Based Nurse Case Management Programs
13. Integrated Case Management Model
14. A Faculty Case Management Practice Based in a College of Nursing
15. A Model of Emergency Department Case Management: Developing Strategies and Outcomes

UNIT V: ADDRESSING HEALTH CARE DELIVERY THROUGH CASE MANAGEMENT: PUBLIC POLICY IMPLICATIONS

16. Patient Demographic Affecting Health Care
17. The Business of Health Care and the Prospective Payment System
18. Patient Mix and Cost Related to Length of Hospital Stay
19. Case Management Legislation: National Attempts to Provide Efficient Health Care
20. The Managed Care Market: Nurse Case Management as a Strategy for Success
21. Financing Health Care in the U.S.: Economic and Policy Implications
22. Public Policy, and Community-Based Case Management: The Nurse-Family Partnership

UNIT VI: THE PLANNING PROCESS: DEVELOPING COLLABORATIVE RELATIONSHIPS

23. Assessing the System and Creating an Environment for Change
24. Case Management Education: Preparing for Successful Implementation
25. The Competency Outcomes and Performance Assessment Model Applied to Nursing Case Management Systems
26. The Role of the Nurse Case Manager
27. Credentialing for Case Management: Licensure, Certification, Certificate Programs, and Accreditation
28. Facilitating Educational and Career Mobility: Online Case Management

UNIV VII: IMPLEMENTATION: TAKING A SYSTEMS PROCESS APPROACH

29. The Cast of Characters
30. Variations Within Clinical Settings
31. Brainstorming: Development of the Multidisciplinary Action Plan (MAP)
32. Interdisciplinary Care Planning and Documentation using NIC and NOC
33. Ethical Issues in Case Management
34. Case Management and Information Technology
35. NEW! Telehealth Applications for Case Management
36. Compliance and Regulation

UNIT VIII: EVALUATION, OUTCOMES MEASUREMENT, AND RESEARCH: IMPORTANT COMPONENTS OF DECISION MAKING

37. Key Functions and Direct Outcomes of Case Management
38. NEW! Case Management: Life at the Intersection of Margin and Mission
39. NEW! Maximizing Reimbursement through Accurate Documentation and Coding
40. The Data-Driven Health Care Environment: Methods of Gathering and Presenting Relevant Data About Health Care Systems
41. The Importance of Research in the Evaluation Process
42. Documentation of Quality Care
43. The Link Between Continuous Quality Improvement and Case Management
44. Job Satisfaction
45. Nurse Case Manager Job Characteristics and Effects on Well-Being
46. Measuring Cost-Effectiveness
47. Case Management Evaluation: The Use of the Cost-Effectiveness Analysis Method
48. Linking the Restructuring of Nursing Care With Outcomes: Conceptualizing the Effects of Nursing Case Management using Measurement and Logic Models
49. An Overview of Assessing Health Through Quality of Life Indicators
50. NEW! Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study
51. Outcomes Effectiveness and Evidence-Based Practice
52. The Carondelet Community-Based Nurse Case Management Program: Yesterday, Today & Tomorrow

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