Role Of Nurse Case Manager Research Articles

Latent tuberculosis infection treatment completion in Biscay: differences between regimens and monitoring approaches.

Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies. To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring. A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022. A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR (n = 699) completed treatment vs. 68.3% (n = 1,260) of those on 6H (p < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care (p < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring. 3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.

Establishment of Nurse Case Manager Role in a Pediatric Orthopedic Team.

Incorporating a nurse case manager (NCM) directly into a pediatric orthopedic department was implemented to address gaps in processes that had previously led to common delays in discharge planning. The orthopedic NCM works within an interdisciplinary team and provides guidance and support for both elective and emergent pediatric admissions. Applying continuous improvement techniques, the NCM role included the review of existing processes and determination of root causes of delays. This article describes some of the unique challenges and new processes included in the NCM role in the pediatric orthopedic setting, several solutions created and implemented to address identified delays, and statistical results of anticipatory discharge planning. An NCM role was initiated in the orthopedic department at a quaternary-level freestanding pediatric hospital. After interdisciplinary planning and implementation, the NCM role was established within the orthopedic department to facilitate timely, efficient, safe, and sustained discharges of patients. Success was realized through decreased denials and decreased number of avoidable inpatient days. Once rapport was established and streamlined work was developed, a retrospective review of length of stay was conducted to compare time periods prior to and after embedding this position. Changes in discharge planning processes positively affected the average length of stay for patients managed by the NCM. Cost savings are found in decreased avoidable inpatient days, decreased number of denials of inpatient medical necessity, and improved progression of care, which resulted in timely transitions and discharges. The effects of a consignment process and web-based ordering of durable medical equipment were also evaluated. Although this process in and of itself did not seem to impact length of stay, it did foster an improvement in team satisfaction around discharge readiness. Pediatric orthopedic service teams benefit from the role of the NCM when there is interdisciplinary involvement and a focus on streamlining processes from preadmission through transition of care. Further study in a concurrent design will shed light on other factors that impact length of stay, such as specific diagnoses and medical complexity. Average length of stay is an effective metric for services with a high percentage of elective admissions but may not be as dependable for teams that do not have prescribed lengths of stay. Study with a specific focus around those factors that impact both team and family satisfaction is also indicated.

Establishment of Nurse Case Manager Role in a Pediatric Orthopedic Team.

Establishment of Nurse Case Manager Role in a Pediatric Orthopedic Team.

Nurse Case Manager Lifestyle Medicine (NCMLM) in the Type Two Diabetes patient concerning post COVID-19 Pandemic management: Integrated-Scoping literature review.

The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quantitative data related to Nurse Case Management programs in Lifestyle Medicine view. Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.

A Literature Review on the Benefits for an Interprofessional Educational Program to Increase Novice Nurse Awareness of Case Management in Heart Failure.

The purpose of this literature review is to examine the potential value for an interprofessional education program to increase novice nurse awareness of case management in heart failure (HF). Acute care health care settings involving novice nurses. Evidence demonstrates that interprofessional collaboration on transitional care interventions for HF patients reduces 30-day readmissions. Implementation of an interprofessional education program for novice nurses can be an effective intervention to decrease readmissions by increasing knowledge of the nurse case manager role and development of interprofessional relationships. Increased awareness of HF case management is important for novice nurses. Understanding the nurse case manager role and early interprofessional collaboration can improve patient health outcomes among the HF population. Therefore, an education program to build confidence and strengthen interprofessional partnership in HF case management for the novice nurse is warranted.

Collaborating for Care

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Nurse case managers: patient care implications at a Pakistani university

The role of the nurse in hospital is varied and some are choosing to incorporate more managerial and administrative skills into their clinical role. One such role is that of the nurse case manager (NCM). This particular role concentrates on involving the family and the patient in his or her own care, facilitation of the care plan, and open discussions between the patient, medics and nursing staff. NCMs in the author's hospital have made a remarkable contribution to patient care. It is a challenging and exceedingly demanding role in both developing and developed countries, but one that is increasingly important. The NCMs are involved in coordination, facilitation of core process and mobilization of resources, not only in hospital but at the patient's home. In this short introductory article the role of NCM is highlighted and the author discusses how this diverse role is concerned with patient care. NCMs work with multidisciplinary teams to enhance the patient's care process. Their attention is also given to cost reduction and clinical pathway management.

Emergency Department–specific Case Management Program

Increased use of the emergency department for nonemergent visits results in ED overcrowding, increased length of stay, and poor utilization of health care dollars. The purpose of this project was to implement an emergency department–specific case management program to reduce utilization of nonemergent visits through enhanced patient education and providing linkages to primary care providers and community resources. Implementation of a performance improvement project for emergency department–specific case management. An urban, level II trauma center with 75,000 annual visits. At-risk patients targeted for case management were defined and supported by review of literature and analysis of ED nonemergent patient demographics. A literature search revealed that patients at risk for fragmented health care included those without a primary care provider, those without health benefits, and those enrolled in Medicaid. An analysis of ED utilization for nonemergent visits in this facility correlated with literature findings. Nonemergent is defined by this institution’s reimbursement coding scale, specifically, evaluation and management levels I and II. Implementation of the registered nurse case manager role included identification of at-risk populations for fragmented health care. Networking with hospital and community resources to develop ways to meet the health care and social needs of at-risk populations was completed. Education of nursing staff, liaisons, and ED physicians regarding available resources and emergency department–specific case management principles, including enhanced patient education, was implemented. Evaluation of at-risk population visits shows a decrease in nonemergent visits by 34% (N = 6852) in 2004. A 2004 focus study showed that of 1062 patients referred to this institution’s outpatient clinic 32% (n = 339) made an appointment. Of these 339 patients, 91% (309) kept their appointments. This study reinforces the need to schedule follow-up appointments while the patient is in the emergency department. A 2004 focus study of 50 randomly selected patients who received 1:1 case manager education revealed that 60% (n = 30) had no return visits, 26% (n = 13) had 1 return visit, 8% (n = 4) had 2 return visits, and 6% (n = 3) had 3 return visits. A random study of 50 patients who qualified to receive staff case management education revealed that 58% (n = 29) had no return visits, 20% (n = 10) had 1 return visit, 4% (n = 2) had 2 return visits, 6% (n = 3) had 3 return visits, and 12% (n = 6) had 4 or more return visits. The finding of similar “no return visits” between staff and case manager suggest that case management staff education was effective. However, the increase in 2 or more visits may be related to the inability of staff to schedule follow-up appointments on the off-shift and possible inconsistency of patient case management education by staff. Limitations identified include the need for consistency by staff in case management patient education and the ability of staff to schedule follow-up appointments. Subsequent actions will include the development of an ED Case Management Core Team, thereby giving case management 24/7 coverage. Because the emergency department continues to be the “safety net” for at-risk populations, implications for expanding the emergency department–specific case management program to include individualized patient care plans is indicated.

Realigning the Communication Paradigm in Nursing Case Management

Communication underlies all of case management (CM), and better comprehension of the processes of communication within the context of the CM role may facilitate positive patient and organizational outcomes, and assist providers and policy makers in designing effective CM systems. Thus, the purpose of this qualitative, pilot project was to explore dimensions of communication of the nurse case manager role within a hospital setting. The results describe a "hub and spoke" model of communications and suggest the utility of this familiar model for understanding the communication dynamics for those who work as nursing case managers in hospital settings. Findings suggest that nurse case managers are at various times both advocates and mediators--communications roles that may encompass somewhat contradictory demands and perspectives.

Nurse Case Manager Role Attributes: Fifteen Years of Evidence-based Literature

Nurse Case Manager Role Attributes: Fifteen Years of Evidence-based Literature

Nurse Case Manager Role Attributes: Fifteen Years of Evidence-based Literature

Nurse case management has been shown to provide quality patient care. Transition into the nurse case manager (NCM) role has presented administrators with a strategy to retain highly experienced registered nurses. An evidence-based literature review was pursued to examine provider and patient satisfaction associated with NCMs in acute and community care practice delivery settings. Qualitative and quantitative empirical findings were gathered to determine consistent role attributes. Autonomy was described as high by NCMs with interdisciplinary collaboration seen as an important practice activity. Mixed results were uncovered in nurse case management's effect upon staff nurse practice as well as patient and provider satisfaction. From the findings generated, recommendations were developed to improve the practice and expectations of the NCM role.

The Role of the Nurse Case Manager in Substance Abuse Treatment

This article describes the evolution of the addiction nurse case manager's role in a substance abuse treatment program and the implementation of an outpatient treatment program based on current treatment trends. Three therapy phases of addiction treatment are described. Phase 1 therapy, is an assessment and educational phase teaching skills and imparting knowledge in coping skills training, 12-step study group, process group, a lecture group, and individual sessions. Phase 2 therapy, although less intensive, continues an educational component in a weekly aftercare group. Weekly meetings with a case manager provide an opportunity for reflection of recovery progress and relapse prevention. During phase 3 therapy the patients consolidate their progress and replace the void left by the drug's absence with relationships in the community. Retention rates and patient satisfaction reports in this program are favorable with reports in literature for outpatient addiction treatment.

Nursing case management for children with failure to thrive

The case management approach is described for children with nonorganic failure to thrive in the pediatric tertiary care setting. An advanced practice nurse facilitated the organization of a planning committee, the construction of a care path, and the evaluation of the case management model. A 4-day care path is presented to show staff nursing functions in the nurse case manager role. Special issues are discussed for developing care paths for organic-based failure to thrive where parent reports can help guide health care interventions.

A case study of nursing case management in a rural hospital.

This article describes the process of implementing a New England model of case management in a rural hospital and the modifications necessary in adapting an urban model to a rural setting. Nursing case management at this institution has been associated with a decrease in the length of stay by 1.7 days at an estimated cost savings of $65,932 for the 16-month study period. Case management has also been instrumental in improving quality of care through a program of continuous quality improvement and in redesigning the RN role. The vision for the future is to extend the nurse case manager role outside the hospital walls to the community in a collaborative plan that would bill nursing services through physicians' offices.

Collaborative practice through nursing case management.

A 528-bed community teaching hospital redesigned its patient care delivery system, implementing a collaborative practice model on the 30-bed inpatient rehabilitation unit in April 1990. This model is a patient-centered delivery model that encourages the healthcare team to facilitate the achievement of patient outcomes within effective time frames and with an appropriate use of resources. The collaborative practice model includes a nurse case manager's role for the staff nurse, which had as its frame-work the concept of nursing case management. Tested project management techniques were used to ensure a successful implementation process. Various strategies, such as using project teams and providing educational programs, were used to respond to the issues of role conflict and overlap, especially between social workers and nurse case managers. The implementation of this model provided a number of benefits, including improved interdisciplinary relationships and decreased length of stay.