Case management is defined as a process where resources are optimally used

Case management is defined as a process where resources are optimally used

cira, second peer post

Question 1

Case management is defined as a process where resources are optimally used, and services are coordinated through a responsible professional core with a specific objective directly on the case (Fabbri, Maria, & Bertolaccini, 2017). It is a collaborative process that involves advocacy, evaluation, facilitation, planning, and assessment of services to meet the comprehensive health needs of families and individuals (Case Management Society of America, 2017). These needs are met through effective communication and efficiency in the use of available resources. According to the Case Management Society of America (2017), the aim is to promote quality of care, patient safety, and enhance the achievement of cost effective outcomes.

Care management is defined as a set of activities whose aim is to help caregivers and patients to manage health conditions effectively, eliminate duplication, enhance coordination of care, and get rid of the need for medical services. These activities have the potential to improve quality and control healthcare costs, particularly among patients with complex conditions. The Agency for Healthcare Research and Quality (2018) defines care management as a team-based, patient-centered approach whose aim is to help patients and their families to manage medical conditions effectively. Successful care management requires coaching, physician involvement, training and personnel, in-person encounters, and the contribution of informal caregivers.

Several differences exist between care management and Case Management. Case management is administered by health plans and is disease-centric (Agency for Healthcare Research and Quality, 2018). On the other hand, care management is organized through appropriate interventions and focuses on the reduction of the cost of care and health risks. In care management, the scope and limit of work are defined by the client, which is the role of agencies in case management.

Care management is a holistic, family/patient-centered approach that focuses on family dynamics and advocates for client’s needs. Case management is a patient-centered approach that considers financial, legal, or medical issues affecting stakeholders. The goal of care management is to improve communication and promote quality of life. It emphasizes the provision of education to patients and their families to ensure that their goals and needs are met. The purpose of case management is to ensure that services are not over-utilized, facilitate cost effective and efficient outcomes, and improve health status.

Question 2

The case management concepts into the clinical practice of community health nursing include; planning, implementation, diagnosis, evaluation, Monitoring, assessment, outcomes, and communication skills (Fabbri, Maria, & Bertolaccini, 2017). Case management requires an assessment of in-depth information to understand the lifestyle, spiritual, cultural, economic, developmental, functional, cognitive, psychological, and physical needs of patients. After the analysis of information, planning should be done to develop an evidence-based, individualized plan of care. The desired outcomes set during planning can only be achieved through activities such as communicating effectively, goal-setting, facilitating, delegating, and intervening during the implementation process. Communication skills are essential in the dissemination and interpretation of complex, detailed financial and clinical information. Nurse case managers should have a clear understanding of these concepts to enhance the efficiency and effectiveness of interventions.

Question 3

A family is a combination of at least two people with emotional, financial, or legal linkages, particularly parents and their children. There are different types of families, including the extended, nuclear, foster, childless, adoptive, single parent, and binuclear family. A nuclear family is the basic social unit made up of couples (parents) and their children (Seven & Akif İnci, 2016). When the nuclear family involves grandparents and close relatives, it becomes an extended family. A family with one parent is a single-parent family. A childless family is made up of couples without children. If a couple provides guardianship to a child or children from poor families or where parents are dead, the family becomes a foster family. An adoptive family has one or more children legally owned by either of the parents were biological ties do not exist. A binuclear family is formed when parents from a nuclear family separate and re-marry.

Several models of care delivery for families exist, including negotiated care tool, family-centered rounds (FCRs), partnership model of care, and others (Curtis, Foster, Mitchell, & Van, 2016). Negotiated care tool is used with existing nursing care. It focuses on developmental play, settling, hygiene, and feeding (Koch, Joos, & Ryding, 2018). FCRs are the standards for hospitalized children necessary for the improvement of safety and quality of health (Cox et al., 2017). According to Treadgold, Dann, and Bowden (2018), the partnership care delivery model has a safe family- and patient-centered care. It includes effective communication, collaborative practice, support, and education.

Questions 4

Researchers have identified five major strategies for moving from intervention at the family level to intervention at the aggregate level. These are, assuring synchronization, creating sustainability, creating intensity, building collaboration, and ensuring consistency of the intervention (Mikkelsen, Novotny, & Gittelsohn, 2016). Consistency can be created through frequent visits to intervention visits and meeting regularly with stakeholders to assure compliance with the protocol. Activities should be planned in cooperation with facilitators and community groups to ensure synchronization (Mikkelsen et al., 2016). Sustainability can be achieved by developing and maintaining relationships with community partnerships and groups. When creating intensity, a participatory action is inevitable in the research approach. Lastly, according to Mikkelsen et al. (2016), partnerships and collaborations can be created by identifying local community groups and involving them in kick-off meetings. These strategies can help achieve the desired outcomes.

References

Agency for Healthcare Research and Quality. (2018, August). Care management: implications for medical practice, health policy, and health services research. Retrieved October 28, 2019, from https://www.ahrq.gov/ncepcr/care/coordination/mgmt...

Case Management Society of America. (2017, June 9). What is a case manager? Retrieved October 28, 2019, from https://www.cmsa.org/who-we-are/what-is-a-case-man…

Cox, E. D., Jacobsohn, G. C., Rajamanickam, V. P., Carayon, P., Kelly, M. M., Wetterneck, T. B., … Brown, R. L. (2017). A family-centered rounds checklist, family engagement, and patient safety: A randomized trial. Official Journal of the American Academy of Pediatrics, 139(5), e20161688. doi:10.1542/peds.2016-1688

Curtis, K., Foster, K., Mitchell, R., &Van, C. (2016). Models of care delivery for families of critically Ill children: An Integrative Review of international literature. Journal of pediatric nursing, 31(3), 330-341. doi:10.1016/j.pedn.2015.11.009

Fabbri, E., Maria, M. D., & Bertolaccini, L. (2017). Case management: an up-to-date review of literature and a proposal of a county utilization. Annals of Translational Medicine, 5(20), 396-396. doi:10.21037/atm.2017.07.26

Koch, R., Joos, S., & Ryding, E. (2018). Negotiating health: Patients’ and guardians’ perspective on “failed” patient-professional interactions in the context of the Swedish health care system. BMC Health Services Research, 18, 1-10. Doi: 10.1186/s12913-018-3160-4

Mikkelsen, B. E., Novotny, R., & Gittelsohn, J. (2016). Multi-Level, multi-component approaches to community based interventions for healthy living—A three case comparison. International Journal of Environmental Research and Public Health, 13, 1-8. Doi: 10.3390/ijerph13101023

Seven, S., & Akif İnci, M. (2016). Social behaviors in nuclear and extended families children age 6 to 11 – A longitudinal study with Turkish sample. International Journal of Social Science and Humanity, 6(2), 81-86. doi:10.7763/ijssh.2016.v6.623

Treadgold, C., Dann, J., & Bowden, A. (2018). Starlight’s healthier futures initiative: A partnership model supporting health care delivery to Indigenous children and adolescents. International Journal of Integrated Care, 18, 90. doi:10.5334/ijic.s1090