Case Management Chapter 7: Quality Management And Outcomes

Question 1

Define performance management.

Answer 1

Uses the processes of design, improvement, measurement, and control

Question 2

Define outcomes management

Answer 2

A process that applies outcomes research to practice, allowing the delivery of evidence based care and treatments. It involves assessment and measurement of performance at one point in time, monitoring and evaluating of performance using the same outcomes over time at specific intervals analysis and interpretation of the results to identify issues or concerns; and taking specific or strategic actions to improve quality and performance.

Question 3

Define risk management

Answer 3

The art and science of not getting sued. Ideally, the major emphasis is on identifying potential risk areas and on interventions that will enhance patient safety and prevent losses including untoward events before they occur. In reality, rm is often called in after the undesirable event and functions to control and minimize the damage

Question 4

Define core measures

Answer 4

National standardized performance measurements system that was first implemented to improve the quality of health care.

Question 5

Describe the process of quality reviews

Answer 5

1. Identification of quality concern
2. Determine if quality problem exists
3. Confirm the existence of quality problem

Question 6

Describe the relationship between case management and quality management

Answer 6

Case managers constantly oversee all aspects of patient care: assessing, reassessing, evaluating, monitoring, and reevaluating. For this reason, case managers are critical team members in the QI, RM team.

Question 7

Explain the role of case managers in quality and outcomes management

Answer 7

Case managers are often involved in eval of effectiveness of cm programs by focusing on identifying key cm related outcome indicators: assessment, measurement, and monitoring of indicators, assessment, measurements and monitoring of these indicators, analyzing and interpreting data and improving effectiveness of cm.

Question 8

List 5 strategies in case management practice that enhance patient safety

Answer 8

Advocacy
Medication reconciliation
Timeliness of care activities and treatment
Timeliness of tests
Communication among providers
Communicating with payer

Question 9

6. Describe the role of the case manager in the reporting of outcomes (core measures).

Answer 9

Case managers are frequently involved in the evaluation of the effectiveness of the case management programs of which they are a part. Such activities cannot be done without a focus on identifying key and strategic case management related outcome indicators: assessment, mearsurment, and monitoring of theses indicators; analyzing and interpreting the data; and finally improving the effectiveness of cm where the opportunity for improvement exists.
(pg. 245)