Case Management Chapter 6: The Case Management Process Flashcards
Case Management Process: Stage 1 Case Selection
The “first cut” This weeds out patient who will not need CM services or the process of selecting those that would most benefit from the service. All patients need screening for this {our acuity we created when we started can help with this}. Diagnosis or chief complaint alone does not determine whether a patient/ family would benefit from case management services. Screening a patient by focusing on the patient/ family’s total situation is the best strategy for deciding on a patient. The earlier the screening the better. Even thought they meet intensity for CM they may not need it depending on other factors (no family, social, financial, psychosocial, re-admission concerns). Some assessment is needed for this (stage 2) determination. Other indicators- lives alone, over 65 years old, Payor source, readmission within 15 days for same issue, Physicians (multiple or complex), First- time mothers, DRG’s. Some indicators include: Psychological, Socioeconomic.
Case Management Process: Stage 2 Assessment/Problem Identification
This assessment should determine patient needs and establish plans that will overcome problems and move the patient forward. This exposes the problems, Goals will take shape, and case manager finds out what gaps need filling, what services are needed, and what quality of life need special focus. Assessment is the critical pivot on which a case manager process revolves. Sources for assessment are as follows: Primary source is the patient. If patient is incapable patients personal support team (family, spouse, parents). Primary Care Provider and records, hospital staff and records (past and present). Patients home. Patients Employer. Several assessment categories to cover are: Patients history and Demographics, Current Medical Status, Nutritional assessment, Medication assessment, Functional assessment, psychosocial assessment, cultural and religious diversity, Care planning activities, screening and assessment tools {depression and sub abuse tool and the questionnaires with them}.
Case Mangement Process: Stage 3 Development and Coordination of the Case Plan
. This is how the case manager determines how to get to the goals created in the assessment stage. The needs and services are matched into a seamless plan based on the assessment data and the desires of the patient and family/caregiver. CREATIVITY is the KEY! Maintain a patient/ family centered approach, be flexible, maintain goals relevant to the patients current condition. This needs to be decided: What needs to be done, how best to do it, who will provide necessary services, when each need will be met, where and when the next level of care will be provided, how the patient/ family can best manage (after discharge). These are the key points to stage 3: Establishing Goals. Prioritizing Needs and Goals. Service Planning and Resource Allocation.
Case Management Process: Stage 4 Implementation of case plan
This is the process of putting the plan into action. By now the patients assessed needs have been linked with private and community services. The gaps are filled in. There is no duplication of services and the patient and support systems are in agreement with the case plan. Goal of this stage is to maximize the safety and well-being of the patient, using the most independent and necessary level of care. Should be the most cost-effective way
Case Management Process: Stage 5 Evaluation and Follow up
This ensures case continuity and sends the patient and family a caring message. Follow up is usually appreciated, and often needed. Complications, questions, new concerns, or issues differing from the plan happen after and this follow up has the potential to catch and correct these before they become large issues. Familial needs are a large part of follow up concerns. Case evaluation helps the case manager and patient determine if the case management was effective and that all goals and objectives were met and are understood.
Case Management Process: Stage 6 Continuous Monitoring, Reassessing, and Reevaluating
This is done until the case is officially closed. So it is not really a stage and the stages are not necessarily done in this order. This will reveal changes in the patient’s medical condition or hidden social circumstances. This will revise, refine and fine tune the service plan. This will determine things such as: Changes in medical status (improvement or deterioration), Changes in Social Stability of the patient, Quality of Care, changes in functional capability and mobility, evolving educational needs, pain management (causes of inadequate pain relief, approaches to pain management, important pain management considerations), changes in patient or family satisfaction, goals.
Case Management Process: Stage 7 Case Closure and Termination of Case Management Services
Closing the case
Criteria that qualify a patient for the case management process
lives alone, over 65 years old, Payor source, readmission within 15 days for same issue, Physicians (multiple or complex), First- time mothers, DRG’s. Some indicators include: Psychological, Socioeconomic. b. Over $50,000, length of stay longer than 5 days.
- Determine the essential components of a case management assessment
a. Patients history and Demographics, Current Medical Status, Nutritional assessment, Medication assessment, Functional assessment, psychosocial assessment, cultural and religious diversity, Care planning activities, screening and assessment tools
Case management plan of care
a. CREATIVITY is the KEY! Maintain a patient/ family centered approach, be flexible, maintain goals relevant to the patients current condition. i. Establishing Goals. Long term and short term. These may have many goals under the primary goal.
ii. Prioritizing Needs and Goals. Get the patient and family input on this. Start working with the family at their level of acceptance with their condition. Remember not all situations can be fixed.
iii. Service Planning and Resource Allocation. Medical insurance company is the first place to look {us}. Second is “informal” resources- family, friends, neighbors, community- based agencies and religious groups, Government entitlements like Medicare, SSD, or Medicaid, geographically convenient resources. Also this can be where you bring several different consultants goals into one overall plan, reducing trauma, costs, and confusion. {multiple surgeries, multiple home cares needed, multiple specialists with different goals- needing organization for patient}
Strategies that ensure effective implementation of the case management plan of care
a. Were the goals and objectives met? Met, not met, and partially met. If it is partially met there needs to be a description as to what this means. Were the goals realistic? Were appropriate treatment, procedures, or case management interventions selected? Were all the essential needs of the patient and family identified and addressed? Did other issues come to light after the initial interventions that demonstrated a new strategy might be more successful or necessary?
b. Were all services delivered as planned?
c. Were there any problems with the agencies or companies that were set up?
d. Are new needs surfacing that are serious enough to destabilize the whole case plan?
Strategies for effective closure of case management services
a. Educate the patient and family about the need for case closure
b. Share the expectation of the case closure with the patient and family at case selection and intake time
c. If case closure is done due to relocation or change in insurance company or provider, the case manager involved should transition the case to the next case manager or provider to maintain continuity of care
d. Answer patient and family questions
e. Alleviate patient and family anxiety
f. Reintroduce the need for case closure a few days prior to the last date of involvement in the case.
