Experience In Management Of Cases Research Articles

Schizophrenia, violence, and case management: Being supportive and overwhelmed.

The aim of this study is to understand the experiences of case managers as they delivered care to women who were diagnosed with schizophrenia and live with histories of violence. Interpretive phenomenology. Providers valued their relationships with women, yet felt overwhelmed and frustrated with aspects of the case management role. Case managers at times blamed women for the violence in their lives and lacked clarity with regard to their role assisting women in recovery. The violence and poverty that is common for these women is a key factor that increased providers' alienation and confusion as to their role in the provision of care. The educational and supportive needs of case managers must be addressed to uphold recovery-oriented services.

The use of Winograd and Vulnerable Elders Survey-13 criteria to evaluate frailty applied to INRCA Comprehensive Geriatric Assessment database

Due to the ageing of the population and the sharp increase in life expectancy, cancer in the older person has become an increasingly common problem in the Western world. Although several authors have stressed that elderly cancer patients deserve special attention as a target group for research efforts, older aged patients are still less likely to be offered participation in clinical trials. The cellular and molecular mechanisms regulating the physiological process of ageing and senescence are far from understood, although inflammation is likely to play an important role, at least in some cancers. In addition, the relationship between ageing and cancer risk is also far from understood. One of the most intriguing aspects of ageing is how different the ageing process is from person to person; the basis for this variation is largely unknown. Population-based studies and longitudinal surveys have shown that comorbidity and physical and mental functioning are important risk factors; thus, a meaningful assessment of comorbidity and disability should be implemented in clinical practice. Modern geriatrics is targeted towards patients with multiple problems. Such patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease, and/or by measuring the response, or survival after treatment. Conversely, it is necessary to conduct a more comprehensive investigation of the ‘functional status’ of the aged person. A geriatric consultation provides a variety of relevant information and enables the healthcare team to manage the complexity of health care in the elderly; this process is referred to as the Comprehensive Geriatric Assessment (CGA). The use of CGA is now being introduced into oncological practice. The definition of frailty is still controversial and represents a major issue of debate in clinical geriatrics. As the frail population increases, clinical trials in frail persons are needed. The usefulness of these trials requires a consensus as to the definition of frailty. Clearly, the management of older persons with cancer requires the acquisition of special skills in the evaluation of the older person and in the recognition and management of emergencies as well as experience in geriatric case management.

CoPing

Sherry L. Aliotta, BSN, RN, CCM, is President and CEO of S.A. Squared of Tennessee, Inc. Sherry founded the company in 1997 to specialize in all aspects of medical management. Her company has worked with hospitals, health plans, universities, physician groups, CMS, grantors, and publishers. Her case management experience spans over 21 years from the front line to vice president of a Health Plan. She speaks and publishes widely both in the United States and internationally, served as CMSA's National President 2004–2005, and was a National Board Member for 3 years prior to her election as president. Her work on the Council for Case Management Accountability and the Case Management Adherence Guidelines supports her passion for establishing credible case management outcomes. In 1996, CMSA named Sherry “Distinguished Case Manager of the Year.” Address correspondence to Sherry L. Aliotta, BSN, RN, CCM, S.A. Squared of Tennessee, Inc., 35 Barksdale Cove, Jackson, TN 38305 (e-mail: [email protected]).

Welcome to CoPing

Sherry L. Aliotta, RN, BC, BSN, CCM, is President and CEO of S.A. Squared of Tennessee, Inc. Sherry founded the company in 1997 to specialize in all aspects of medical management. Her company has worked with hospitals, health plans, universities, physician groups, CMS, grantors, and publishers. Her case management experience spans over 21 years from the front line to Vice President of a Health Plan. She speaks and publishes widely both in the United States and internationally. She served as CMSA's National President 2004–2005, and was a National Board Member for 3 years prior to her election as President.

Welcome to CoPing

Sherry L. Aliotta, BSN, RN-C, CCM, is president and CEO of S. A. Squared of Tennessee, Inc. Sherry founded the company in 1997 to specialize in all aspects of medical management. Her company has worked with hospitals, health plans, universities, physician groups, CMS, grantors, and publishers. Her case management experience spans over 21 years from the front line to vice president of a health plan. She speaks and publishes widely both in the United States and internationally. She served as the CMSA's National President 2004—2005, and was a national board member for 3 years prior to her election as president. Her work on the Council for Case Management Accountability and the Case Management Adherence Guidelines supports her passion for establishing credible case management outcomes. In 1996, the CMSA named Sherry “Distinguished Case Manager of the Year.” Address Correspondence to Sherry L. Aliotta, BSN, RN-C, CCM, S.A. Squared of Tennessee, Inc, 35 Barksdale Cove, Jackson, TN 38305 (www.sa2cm.com).

A Qualitative Study on the Social Workers’ Perception and Subjective Experience of Case Management in Community Welfare Centers

A Qualitative Study on the Social Workers’ Perception and Subjective Experience of Case Management in Community Welfare Centers

Patient and carer perceptions of case management for long-term conditions

Nurse-led case management programmes have become increasingly popular over the last 15 years. Countries such as the USA, Canada, Sweden and the Netherlands have long running case management programmes in place for frail elderly people. The Department of Health in England has recently introduced a 'community matron' role to provide case management to patients with highly complex long-term conditions; a group that is predominantly comprised of elderly people. Department of Health policy documents do not define the day-to-day role of community matrons but instead describe the objectives and principles of case management for long-term conditions. The aim of this qualitative study was to describe case management from the perspective of patients and carers in order to develop a clearer understanding of how the model is being delivered for patients with long-term conditions. In-depth interviews were conducted with a purposive sample of 72 patients and 52 carers who had experience of case management. Five categories of case management tasks emerged from the data: clinical care, co-ordination of care, education, advocacy and psychosocial support. Psychosocial support was emphasised by both patients and carers, and was viewed as equally important to clinical care. Patient and carer perceptions of case management appear to contrast with descriptions contained in Department of Health guidance, suggesting an 'implementation surplus' in relation to the policy. This particularly appears to be the case for psychosocial support activities, which are not described in official policy documents. The provision of significant psychosocial support by community matrons also appears to differentiate the model from most other case management programmes for frail elderly people described in the literature. The findings emphasise the importance of seeking patient and carer input when designing new case management programmes.

Effective Workers' Compensation Nurse Case Management

Sharron Edgar, RN, CCM, CDMS, CRRN, QRP, has more than 30 years of nursing experience and more recently, 8 years of case management experience in Florida's workers' compensation field. Sharron can be contacted telephonically at 407-788-6990 or via e-mail at [email protected].

Venous Strokes

Management of Venous strokes with the KEM Protocol. Our experience in management of acute and sub-acute cases of venous strokes with heparin or local thrombolysis with urokinase according to KEM Hospital, INR protocol will be presented. All patients included had angiographically proven cerebral venous sinus thrombosis. Patients were classified according to clinical status scale into mild1–3 and severe clinical grade4–6. The study was divided into three phases. Phase I included 27 patients all treated with systemic heparin. Phase Il included 72 patients, 30 were in severe clinical grade and 52 in mild. 26 were thrombolysed with 14 in severe and 12 in mild clinical grade. A prospective study was carried out in 180 patients according to a defined protocol in Phase 111. 133 of these were in mild clinical grade and 47 in the severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild & 40 in severe clinical grade. 113 patients were treated with systemic heparin. Adjunctive medical therapy was given as required. Following acute management all were anticoagulated for 6 months. Phase I showed 100% mortality in severe clinical group and 23.53% in mild clinical grade. In Phase II mortality in severe clinical group was 75% in non-thrombolysed group and 57.14% in thrombolysed group. There were no deaths in mild clinical grade patients who were thrombolysed. In Phase 111 in Severe clinical grade, mortality in thrombolysed group was 35% and non-thrombolysed group was 100%. In mild clinical group there was 100% recovery in thrombolysed group and 94.4% in non-thrombolysed group. There was complete clinical recovery in 84.4% of patients in Phase 111. 2 patients had intracranial haemorrhage on Urokinase therapy. The line of treatment of venous strokes with heparin or local thrombolysis can be decided according to the KEM protocol. Patients with Cerebral venous sinus thrombosis had better outcome when managed according to our protocol.

Liability implications of physician-directed care coordination.

Various public and private initiatives encourage physicians to coordinate care for patients who have multiple chronic conditions, but physicians may resist doing so for fear of liability. This article assesses the extent of liability risk. This qualitative study combines legal research with key informant interviews. Relevant legal authorities were identified through literature searches in legal databases. In-depth interviews were conducted with a purposive sample of 16 key informants who have relevant expertise in malpractice insurance, risk management, or liability law. Additionally, 19 other participants with relevant experience in case management or managed care were briefly queried about their liability experience relating to care management. Some aspects of care coordination for patients with multiple chronic conditions hold potential for higher liability. Physicians coordinating care have a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes. Care coordinators may be held to a higher standard of care by adopting best practices guidelines or by making medical decisions on issues that require specialized expertise. Other aspects, however, lower liability risk: elderly patients are less likely to sue, care coordination should improve outcomes, and the information systems that support enhanced care coordination target the major sources of medical error in primary care. On balance, the liability risks of care coordination are commensurate with other risks in primary care practice. Liability insurers indicated no reluctance to insure physicians who coordinate care for patients with multiple chronic conditions and no strong tendency to attribute higher risk to this role. Physicians who currently perform these or similar functions have not encountered demonstrably higher liability. Physicians' perceptions about the liability risks of coordinating care for patients with multiple chronic conditions do not match evidence about the factors actually driving liability. It appears from many informed sources that there is no strong basis for physicians who perform these functions to have serious concerns about liability; instead, care coordination done well may lower liability risks.

An experience of social work case management for frail elders in Hong Kong

Eighty‐three hospital‐discharged elders were served by a social work case manager in our 18‐month case management project in July 2000. Results indicate that elderly care‐recipients utilized less hospital services without sacrificing the quality‐of‐life of their informal carers. This paper shares the experience in the process of case management interventions and suggests strategies to implement case management interventions successfully.

Components of successful HIV/AIDS case management in Alaska Native villages.

Case management is a valuable support service for HIV/AIDS patients, but little is known about the elements of case management that contribute to success for Alaska Natives living in remote rural villages. This study used qualitative data from 18 key informants (social services/health workers, family members, and tribal leaders) to identify the elements of successful case management. Two major categories dominated the analysis. First, the case management organization possessed attributes, such as location, coordination, and support for professionals, that contributed to a positive case management experience. Second, the case manager had both knowledge/professional skills and values with personal capabilities that contributed to positive experiences. These components of successful case management can be integrated into existing and future case management programs for Alaska Natives to improve client level outcomes.

Beginning Practice with Preoperative Male-to-Female Transgender Clients

Preoperative male-to-female transgender clients often present with specific and unique psychological and social issues distinct from gay male and lesbian clients. Therapists must be ready to assess and help diagnose these in preparation for work with gender queer clients. Therapists must also be prepared to face and resolve the various counter-transference dynamics inherent in therapeutic relationships with transgendered individuals. This Practice Note focuses on the author's beginning clinical and social case management experience working with two preoperative male-to-female transgender individuals.

Emerging and re-emerging infectious diseases.

In human history, numerous infectious diseases have emerged and re-emerged. Aside from many others, the so-called 'exotic' agents in particular are a threat to our public health systems due to limited experience in case management and lack of appropriate resources. Many of these agents are zoonotic in origin and transmitted from animals to man either directly or via vectors. The reservoirs are often infected subclinically or asymptomatically and the distribution of the diseases basically reflects the range and the population dynamics of their reservoir hosts. As examples, emergence/re-emergence is discussed here for diseases caused by filoviruses, hantaviruses, paramyxoviruses, flaviviruses and Yersinia pestis. In addition, bioterrorism is addressed as one factor which has now to be considered in infectious disease emergence/re-emergence. Preparedness for known and unknown infectious diseases will be a top priority for our public health systems in the beginning of the millennium.

Advanced practice nurses as faculty.

This article details a program through which two child health faculty members who are advanced practice nurses (APNs) combined practice with teaching undergraduate students in a community-based clinical experience on nursing case management. A collaborative agreement between a university-based Children's Special Services Team (CSST) and school of nursing faculty was developed to extend services into the home communities of children with special healthcare needs. Senior students made visits to the homes of the team's clients, conducted assessments, interacted with families, and provided additional care. The team, which included physicians, nurses, a social worker, and therapists (occupational and physical) identified children and families who would benefit from home visits by students nurses who were directed by APNs. Both service and educational goals were accomplished by this community-based case-management experience. The children and their families received additional care from multiple healthcare providers. Students practiced components of community-based case management, and the CSST obtained vital information about their clients' living environments.

A Social Work Case Management Experience in a Managed Care Setting: The Need for Effective Communication

Many systems come together to provide for the health care needs of an individual. Case management is practiced by several professional disciplines in various settings. It is in the best interest of the consumers to have case managers collaborate so that each professional specialty may be fully realized. The social work case manager in a managed care setting is a psychosocial resource in the health care continuum.

Social Service and Case Management Needs of HIV-infected Persons Upon Release From Prison/Jail

This study sought to identify social service needs of HIV-infected persons at the time of release from prison/jail and to describe their case management experiences after release from prison/jail. Sixteen men and women who were infected with HIV, each with a history of incarceration, participated in one of three focus group sessions. Study participants consisted of 11 men and five women. The majority of the participants were African-American (81%), single (50%), and currently unemployed (69%). Qualitative analysis of the focus group transcripts revealed a total of 483 comments regarding a need for social or health services. These comments were further grouped into 13 categories of services or service-related issues that represented the range of the responses. Although participants described positive experiences with specific case managers, their overall evaluation of case management was negative. Identified social services needs and the descriptions of their experiences with case management provides insight as to how case management services can be improved for this population.

Being a case manager for persons with borderline personality disorder: Perspectives of community mental health center clinicians

The scope of case management has expanded to include persons with chronic, nonpsychotic disorders, in particular, persons diagnosed with borderline personality disorder. Despite more widespread use, literature about case management for persons with this disorder is limited. To address this gap in knowledge, a study of the day-to-day experiences of case managers who care for persons with borderline personality disorder was conducted. Seventeen community mental health center case managers gave their informed consent to participate in individual, in-depth interviews. The interviews were analyzed using an interpretive phenomenological research approach. The analysis showed a pattern of monitoring self-involvement. The case managers monitored themselves in terms of expressing concern and setting boundaries. These shared practices highlight a central and unique component of being a case manager for persons with borderline personality disorder, that is, the case manager's focus of attention is on self. By focusing on the self, case managers seek to retain control of the nature of the relationship. The author asserts that the matter to be resolved is not to determine whether retaining or relinquishing control is better, but rather, how best to help practitioners maintain a helpful relationship over time with persons who have borderline personality disorder. In an effort to accomplish this goal, questions about current helping practices and suggestions for working collaboratively with persons who have this diagnosis are provided.

How nurses can build trusting relationships with clients.

This article presents another review from the Network for Psychiatric Nursing Research (NPNR) National Journal Club. The article reviewed was Repper et al's (1994) ‘How can nurses build trusting relationships with people who have severe and long-term mental health problems? Experiences of case managers and their clients.’ The collated feedback comments from the regional journal clubs is based on the format proposed by Cormack (1991). The views expressed in this review are those of the journal club members and not necessarily those of the NPNR.

Health Care in the Community, Interdisciplinary Professional Education for Students in Dietetics, Nursing and Osteopathic Medicine

Deans from three colleges selected tenured faculty to design and implement an interdisciplinary course to meet the need for active learning experiences for students across disciplines and an under-served city population with limited access to health care. A two credit course was designed with objectives in 3 areas: l) Community Service–plan and conduct 2-3 health screenings responding to family health needs; identify and prioritize client needs based on a team assessment; facilitate clients’ entry into the local health care system; 2) Professional Relationships–develop attitudes of mutual respect and practice collaborative case management; and 3) Professional Education–apply clinical skills in home and clinic settings to the in assessment of clients such as–vital signs, anthropometrics, dietary habits, and blood glucose, cholesterol and hemoglobin. Desirable class size was 21 with equal numbers recruited from seniors in Dietetics and Nursing, and 1st or 2 nd year O.M. students. Small group activities throughout the semester were designed to facilitate cross discipline interactions such as visits to community sites, short presentations on health topics, organization and implementation of 3 health screenings, follow-up home visits and small group counseling. Community members benefit by gaining access to free health screenings, health information, referrals and counseling monitored by seasoned health professionals. Students gain clinical, interpersonal and case management experience. Faculty members broaden their perspectives and knowledge by sharing clinical information and by jointly evaluating students. The colleges and university benefit via visibility within the community. The costs of such a course relate to the faculty time involved in designing and maintaining the interdisciplinary approach in an off-campus setting. The colleges view the high labor cost off the course as far surpassed by the benefits of the university's presence in the community and the benefits to faculty and students.