Why Case Management?

Nursing leadership: new initiatives in case management

Since the early 1980s, policymakers and analysts have urged hospitals to be more active in managing the care of their patients beyond the hospital walls. In particular, hospitals have been criticized for failing to address the postdischarge needs of elderly patients with chronic health problems. An influential essay in The New England Journal of Medicine observed that “most of these institutions have no comprehensive geriatric program geared to the long-term medical, rehabilitative, and social needs that are linked to acute illness. To provide quality care, hospitals must make a commitment to long-term care for the chronically ill elderly patient. It is becoming apparent that no one else can.” As part of a strategy for addressing this perceived shortcoming, the authors argued, “Unlike other providers, hospitals could offer comprehensive case management of patients, from home care to acute care, thus ensuring continuity of services.” Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results. Since many of these activities would take place after the patient left the hospital, hospital-based case management would be a considerable extension of hospitals’ typical discharge planning activities. In part, it was expected that the costs of hospital-based case management programs would be covered through user fees. If the hospital also offered long-term care services, hospital-based case management could generate additional revenues through increased use of these services. If it facilitated the earlier discharge of Medicare patients and reduced Medi-

With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services. Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed. Homeless women with symptoms of mental illness showed higher rates of service use in behavioral, medical, and human domains, a finding that indicates that there are stronger service linkages for this group than for women without symptoms of mental illness. Predictors associated with service use differed by psychiatric symptoms among homeless women: predisposing and enabling factors influenced service use among homeless women without symptoms of mental illness, whereas need factors influenced service use among women with symptoms of mental illness. Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Background: Poor management of disciplinary cases in the South African public service departments is on the rise. The management of disciplinary cases, amongst other things, has drawn considerable criticism from within the public sector, various media outlets, interest groups and even opposition movements. The government has adopted progressive discipline prescripts to inculcate and promote a culture of professional ethics and accountability. In the workplace, objectivity, consistency and fairness are an important part of healthy employer–employee ties.Aim: The study sought to obtain an in-depth understanding of disciplinary cases and describe the challenges senior managers face when managing disciplinary cases in the public service departments.Setting: Both the national and provincial public service departments of South Africa.Methods: The study adopted qualitative modernistic research approach. Semi-structured electronic questionnaire was used to collect views from 751 senior managers.Results: Public service employees are deprived of organisational justice because of weaknesses associated with the discipline management. This is because management of disciplinary cases and sanctions in most national and provincial departments in the public service is perilous and incongruent with the discipline management prescripts.Conclusion: Based on the findings, the current practices do not deter future violations of discipline management prescripts; inconsistent, unfairness and injustice application of sanctions and management of cases and future misconduct in the workplace. Therefore, the authors recommend the use of team-based and progressive discipline to ensure that staff contribute effectively, efficiently and ethically to the goals of the government. The present study contributes to the existing body of knowledge on human resource management and organisational behaviour and provides a platform that broadens an understanding of the amplifying toxic management of disciplinary cases in the South African public service context.

BackgroundThe use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR.Methods80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed.ResultsIn total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training.ConclusionsThis survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work.

Assessing Outcomes for Consumers in New York's Assisted Outpatient Treatment Program

Objectives:This is the second of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as a global pandemic. Part II continues to describe reenvisioned roles and responsibilities of case managers and their leaders to meet the needs of patients/support systems during the crisis. It focuses on the increased need for end-of-life care, impact on workers' compensation case management practice, and the self-care needs of the professional case manager.Primary Practice Settings:Applicable to the various case management practice settings across the continuum of health and human services, with special focus on acute care.Findings/ConclusionsThe COVID-19 global pandemic has resulted in a crisis case managers and other health care professionals never faced something like it before. At the same time, it has provided opportunities for innovation and creativity including use of digital and telecommunication technology in new ways to ensure the continued delivery of health and human services to those who need them regardless of location. It has also resulted in the development of necessary and impactful partnerships within and across different health care organizations and diverse professional disciplines. Most importantly, this pandemic has required special attention to the increased need of patients for timely palliative and end-of-life care. In addition, it has prompted a focus on the safety, health, and well-being of case managers and other health care professionals, resulting in expanded workers' compensation case management practice coupled with the need for self-care and resilience.Implications for Case Management Practice:Professional case managers are integral members of interprofessional health care teams. Their roles and responsibilities are even more necessary during the uncertainty of a global pandemic such as COVID-19. So far, the experience of this crisis has resulted in a deliberate need to ensure the safety of both, those who are the recipients of health care services and those who are responsible for the provision of care. Self-care and resilience of health care professionals and case managers, especially due to the complex dynamics of the COVID-19 pandemic, have advanced a desirable and necessary view of remote/virtual practice and as a strategy for enhancing the person's health and well-being. This pandemic has forced the development of impactful partnerships and collaborations among the diverse contexts of health care organizations and support service providers. These contexts of care delivery have also emphasized the necessary legal and ethical practice of case managers and the other involved parties. Experts agree that the innovative care delivery methods practiced during the pandemic will undoubtedly remain as desirable beyond the current crisis period.

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

I thought that most health care professionals, and ertainly case managers, were beyond segregating physical health, mental health, and behavioral health. However, I was mistaken. As recently as last week, I overheard a hospital case manager tell her manager that she was not trained in mental health

The demand for judicial attention will continue to exceed the supply of judicial time. Various solutions have been suggested to counter the rising caseload. Examples are a reduction of the number of court applications, an increase in the number of judges, and improving the efficiency of the courts with the introduction of appropriate case and court management instruments. Court management and case management are critical components within an efficient judicial system. They depend on the court structure and arrangements within and between the courts both from a horizontal and from a vertical point of view. The structural design of a judicial system depends on multiple factors, including legal culture and policy. This contribution explores, from a comparative perspective, the theories of case management, the role of managerial judges, and the interrelations between court structure, court management and case management. It is evident that case management is dependent on the structural arrangement of courts. In particular, the availability of specialized courts, the flexible composition of the tribunal that corresponds to the complexity and the importance of the case, and the interplay between superior and inferior courts are all critical in ensuring effective case management.

Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking clients to adequate services rather than reporting performance. Case managers favored measurable deliverables rather than operational work products. A proposed solution to current challenges emphasizes and encourages the iterative learning process and shared decision making between program targets, funders and providers. Case managers are aware of the challenging environment in which they operate for their clients and for themselves. However, future interventions will require clearly identified performance measures and increased systems support.

Who Terminates From ACT and Why? Data From the National VA Mental Health Intensive Case Management Program

In October 2018, the Case Management Society of America (CMSA) and the greater case management community celebrates National Case Management Week, a time to honor and recognize all professional case managers across the continuum of care in the United States. Case management has been practiced in the United States for over half of a century, and through that period we have assisted our patients and our clients in developing their plans to “move to wellness.”This year's National Case Management Week logo reflects that movement; just as the CMSA's Standards of Practice for Case Management prescribe, we assess, plan, collaborate, implement, monitor, and evaluate our patients and clients to achieve improved outcomes. True professional case management requires a patient or client-centered approach, with influencers assisting along the way. If someone asked you “what you do” in more detail, what would you say? What is the true value of a case manager from the perspective of the patient or family caregiver? Although we know our value, here are some facts to ponder about our very significant work. Case Management Services Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while utilizing available resources timely and cost-effectively to obtain optimum value for both the patient and the reimbursement source. Coordination of care, managing multidisciplinary teams, and achieving better transitions of care are the pillars of effective case management. We provide expertise and clarity to complex medical issues, including identifying obstacles to the delivery of prompt quality health care treatment and coordinating resources. We are professionals who provide strategies to address challenges and ensure that care is patient-centered, safe, and effective. The key is in the coordination of care, with identified time frames for accomplishing appropriate care outcomes. Case management also provides a well-coordinated care experience to improve the care outcome, decrease the length of stay, and use multiple disciplines and services efficiently. Transitions of care for people with multiple, serious chronic illnesses are critical points for promoting quality of care and reducing preventable, expensive, and debilitating hospital admissions and readmissions as well as avoidable emergency department visits. Most people with multiple chronic illnesses, which are often accompanied by functional and cognitive deficits, cannot manage their care on their own. Wherever and however they originate, care transitions are about addressing change over time and this must be addressed in health care reform, which must support reimbursements accordingly. Case management is neither linear nor a one-way exercise, but rather a longitudinal approach across health care settings that is imperative to coordinate inpatient and postdischarge care. Facilitation, coordination, and collaboration occur throughout the client's health care encounter. Legal and Care Reform From a legal perspective, there is a myth and faulty belief among case managers and other experts that the standard of care is static, fixed, and permanent. The standard of care is a very important legal construct, as it is the standard against which we are judged in malpractice suits and licensing board hearings. Most broadly, the standard of care is defined as the usual and customary professional standard practice in the community. It describes the qualities and conditions that prevail, or should prevail, in a particular mental health service and that a reasonable, average, and prudent practitioner follows. Generally, as more therapists practice in a new and unique way, this new way gradually becomes part of the standard of care. The standard of care is derived from statutes, case law, licensing board regulations, consensus of the professionals and community, and ethical codes. The standard of care is not a standard of perfection, black and white, determined by outcome, permanent, or fixed. It does not follow any particular theoretical orientation, nor is it guided by risk management principles. Health care and case management are constantly changing, and it is our job as professionals, clinicians, and community members to make sure that we can continue to provide the highest level of care coordination possible for our citizens. We at CMSA feel that we are doing our best work to ensure the role of the professional case manager is known and respected by all health care professionals, policy makers, and consumers of health care services. Future of Case Management Anyone who reads the aforementioned discussion will recognize the importance, weight, and responsibility involved in being a case manager. The practice of case management is not easy, but the reward of rich relationships with clients, their families, and colleagues is immeasurable. We have come a long way in our educational endeavors, but we have more work that needs to be accomplished. If you are not already a member of CMSA, please visit cmsa.org to learn not only about how we are celebrating National Case Management Week but also about all of the resources we make available for you to be successful throughout the year in this wonderful practice. Truly, I am blessed to be a member and leader of CMSA and to learn from our membership each and every day. I often say that you were born caring, you worked hard to gain the experience, and with the right tools we can change the world. Finally, when you're having a rough day, remember this phrase: “I'm not saying I'm wonderwoman, I'm just saying no one has ever seen me and wonderwoman in a room together.” We are wonderwomen and men! During National Case Management Week 2018, we will celebrate the fabulous world of case management, right alongside you! Sincerely, Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN CMSA Executive Director

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.