continuity of care-care management

Chapter 25

Case Management

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1

Define continuity of care, care management, case management, care coordination, population health management, transitional care, integrated care, social determinants of health, and advocacy.

Describe the scope of practice, roles, and functions of a case manager.

Compare and contrast the nursing process with processes of case management and advocacy.

Objectives (1 of 2)

Copyright © 2020 by Elsevier Inc. All rights reserved.

2

 

2

Identify methods to manage conflict, as well as the process of achieving collaboration.

Define and explain the legal and ethical issues confronting case managers.

Objectives (2 of 2)

Copyright © 2020 by Elsevier Inc. All rights reserved.

3

 

3

Population management

Social mandate

Care management

Utilization management

Critical pathways

Disease management

Demand management

Definitions

Copyright © 2020 by Elsevier Inc. All rights reserved.

4

 

4

Case management and the nursing process

Characteristics and roles

Knowledge and skill requisites

Tools of case managers

Historical evidence

Contemporary evidence

Concepts of Case Management

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5

 

5

Assessment

Diagnosis

Planning for outcomes

Implementation

Evaluation

Case Management and the Nursing Process

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6

See Table 25.1, The Nursing Process and Case Management.

6

Case Management Roles

Broker

Consultant

Coordinator

Educator

Facilitator

Liaison

Mentor

Monitor/reporter

Negotiator

Client advocate

Researcher

Standardization monitor

Systems allocator

Copyright © 2020 by Elsevier Inc. All rights reserved.

7

See Box 25.1, Case Manager Roles, for descriptions of these roles.

7

Factors That Demand Case Management Attention

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8

Fig. 25.4: Factors that require the attention of the nurse and client in the case management process

8

Knowledge and Skill Requisites

Standards of practice for case management

Evidence-based practice guidelines

Knowledge of the health care financial environment

Clinical knowledge, skill, and maturity

Care resources

Transition planning

Management skills

Teaching, counseling, and education skills

Program evaluation and research

Performance improvement techniques

Peer consultation and evaluation

Requirements of eligibility and benefit parameters by third-party payers

Legal and ethical issues

Information management systems

Health care legislation/policy

Technical information skills

Outcomes management and applied research

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