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

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

by Elaine Cohen


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

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, andregulatory 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.

Product Details

ISBN-13: 2900323027655
Publisher: Elsevier Health Sciences
Publication date: 08/26/2004
Edition description: Revised
Pages: 640
Product dimensions: 7.54(w) x 9.50(h) x 0.44(d)

About 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

Table of Contents

Unit IEvolution of Case Management
1Evolution of Nursing Case Management in a Changing Health Care System3
2Historical Perspective of Nursing Care Delivery Models Within the Hospital Setting12
3Historical Development of Case Management18
Unit IIContemporary Models of Case Management
4Dimensions of Nursing Case Management27
5Two Strategies for Managing Care: Care Management and Case Management33
6Disease Management: Applying Systems Thinking to Quality Patient Care Delivery38
Unit IIIContemporary Models of Case Management: Within-the-Walls Case Management
7Within-the-Walls Case Management: An Acute Care-Based Nursing Case Management Model55
8Collaborative Models of Case Management79
9Case Management: A Process, Not a Person87
10The University of Colorado Hospital Psychiatric Service Health Case Management Model: An Innovative Approach to Client-Centered Care97
Unit IVContemporary Models of Case Management: Beyond-the-Walls Case Management
11Beyond-the-Walls Case Management125
12Outcomes of Community-Based Nurse Case Management Programs129
13Integrated Case Management Model141
14A Faculty Case Management Practice Based in a College of Nursing157
15A Model of Emergency Department Case Management: Developing Strategies and Outcomes166
Unit VAddressing Health Care Delivery Through Case Management: Public Policy Implications
16Patient Demographics Affecting Health Care181
17The Business of Health Care and the Prospective Payment System188
18Patient Mix and Cost Related to Length of Hospital Stay196
19Case Management Legislation: National Attempts to Provide Efficient Health Care204
20The Managed Care Market: Nurse Case Management as a Strategy for Success210
21Financing Health Care in the United States: Economic and Policy Implications219
22Public Policy and Community-Based Case Management: The Nurse-Family Partnership227
Unit VIThe Planning Process: Developing Collaborative Relationships
23Assessing the System and Creating an Environment for Change241
24Case Management Education: Preparing for Successful Implementation250
25The Competency Outcomes and Performance Assessment Model Applied to Nursing Case Management Systems263
26The Role of the Nurse Case Manager277
27Credentialing for Case Management: Licensure, Certification, Certificate Programs, and Accreditation296
28Facilitating Educational and Career Mobility: Online Case Management311
Unit VIIImplementation: Taking A Systems Process Approach
29The Cast of Characters325
30Variations Within Clinical Settings332
31Brainstorming: Development of the Multidisciplinary Action Plan339
32Interdisciplinary Care Planning and Documentation Using Nursing Interventions and Nursing Outcomes Classifications352
33Ethical Issues in Case Management361
34Case Management and Information Technology380
35Telehealth Applications for Case Management384
36Compliance and Regulation397
Unit VIIIEvaluation, Outcomes Measurement, and Research: Important Components of Decision Making
37Key Functions and Direct Outcomes of Case Management415
38Case Management: Life at the Intersection of Margin and Mission423
39Maximizing Reimbursement Through Accurate Documentation and Coding433
40The Data-Driven Health Care Environment: Methods of Gathering and Presenting Relevant Data About Health Care Systems444
41The Importance of Research in the Evaluation Process462
42Documentation of Quality Care468
43The Link Between Continuous Quality Improvement and Case Management477
44Job Satisfaction487
45Nurse Case Manager Job Characteristics and Effects on Well-Being494
46Measuring Cost-Effectiveness513
47Case Management Evaluation: The Use of the Cost-Effectiveness Analysis Method523
48Linking the Restructuring of Nursing Care With Outcomes: Conceptualizing the Effects of Nursing Case Management Using Measurement and Logic Models548
49An Overview of Assessing Health Through Quality of Life Indicators560
50Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study566
51Outcomes Effectiveness and Evidence-Based Practice572
52The Carondelet Community-Based Nurse Case Management Program: Yesterday, Today, and Tomorrow580

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