Nurse Case Management Research Articles

Cost-effectiveness of a preventive self-care health management program for community-dwelling older adults: a randomised controlled trial.

To examine the cost-effectiveness of a preventive self-care health management program for community-dwelling older adults as compared to usual care. A cost-effectiveness analysis was executed alongside a randomised controlled trial. Nurse case managers provided interventions, including holistic assessment, empowerment of self-care, preventive health behaviours and self-efficacy with co-produced care planning, supported by nursing students. The control group received social control calls. Community-dwelling older adults were randomly assigned to the intervention (n = 271) or control (n = 269) group. The intervention was conducted in collaboration with 11 community centres under four non-government organisations in various districts of Hong Kong. Cost and quality-adjusted life years (QALYs) were collected pre (baseline, 0months) and post intervention (3months) and 3months after completion of the program (6months). Incremental cost-effectiveness ratios between the groups were calculated, dividing the difference in cost by the difference in QALYs. Analysis showed that the net incremental QALY gain was 0.0014 (3months) and 0.0033 (6months) when the intervention group was compared to the control group. The probability of being cost-effective at 6months was 53.2% and 53.4%, based on the cost-effectiveness thresholds recommended by both the National Institute for Health and Clinical Excellence ($200,000/QALYs) and the World Health Organization (Hong Kong gross domestic product/capita, HK$381,780). The results provide some evidence to suggest that the addition of a home-based, preventive self-care health management program may have effects on cost outcomes for community-dwelling older adults in Hong Kong.

A Fast-Track Care by a Nursing Case Management Concept Improved Status Epilepticus Outcomes.

Status epilepticus (SE) is an emergency neurological condition, which is life-threatening, results in high morbidity and mortality rates, and needs to be diagnosed and promptly cared for. This study aimed to develop and evaluate the SE fast-track care using a nursing case management concept on SE outcomes. Quasi-experimental study conducted in adult patients with SE admitted in 15 emergency and intensive critical/intermediate care wards. SE outcomes were evaluated and compared between preintervention and postintervention. Time to treatment was reduced from 30 minutes to 3.5 minutes (P < .001). Similarly, the seizure control rate increased from 65.7% to 94.4% (P = .009). The mortality rate was reduced but did not reach statistical significance (8.6% vs 0%; P = .115). The intervention also reduced average waiting time for receiving antiepileptic drugs from the pharmacy department from 13.09 minutes to < 1 minute. The development of the fast-track care system for SE patients by nursing case management is at the core of management for coordinating multidisciplinary teams. This can improve outcomes by reducing the time to diagnosis and treatment time, therefore reducing mortality rates in SE patients.

Care Coordination: A Principle of 21st Century School Nursing Practice With a Focus on Case Management.

The Framework for 21st Century School Nursing Practice™, created by the National Association of School Nurses (NASN), explains school nursing practice, providing guidance, organization, prioritization, and meaning. This is the second article in a series for The Framework for 21st Century School Nursing Practice. This article focuses on case management, one of the practice components in the principle of care coordination. Case management focuses on school nurse support of individual at-risk students and collaborative actions to reduce barriers to their academic success. This article will clarify how the terms care coordination and case management are used in context of the Framework and provide an example to help the reader apply the concept to practice. Washington's School Nurse Case Management Program will serve as a model. The program outlines evidence for effective practice and shares practical examples of how school nurses can implement case management into their daily work. Any school nurse, no matter how large or small their workload, can provide case management.

651-P: Randomized Controlled Trial of Technology-Assisted Case Management in Low-Income Adults with Type 2 Diabetes (TACM-DM): Effect on Quality of Life and Blood Pressure

A novel RCT tested the efficacy of a technology-assisted case management (TACM) program in a low-income, rural population previously where nurses titrated medication over the phone instead of in a clinic. The primary analysis showed significant improvement in glycemic control at 6-months post-randomization dropping HbA1c by 1%. This study aimed to test if the intervention was also effective at dropping blood pressure without compromising quality of life. One hundred and thirteen adults with poorly controlled diabetes (HbA1c&amp;gt;= 8%) were randomly assigned to the TACM intervention or usual care. Participants received a two-in-one telehealth system to monitor glycemic and blood pressure control, which uploaded daily to a central server. A nurse case manager was trained to titrate medication under the supervision of an internist and an endocrinologist every 2 weeks based on the readings. Outcomes were blood pressure and quality of life (SF-12) at 6-months. Baseline adjusted mixed models using a random intercept were used to evaluate change at 6-months for the TACM intervention group compared to usual care. There were no statistically significant differences in systolic blood pressure, physical component of quality of life, or mental component of quality of life between the TACM and control group. However, there was a significant change in diastolic blood pressure over time, with the TACM group decreasing at 6-month (p=0.02), whereas the control group remained stable (p=0.53). Diastolic blood pressure decreased 5.22 mm Hg at 6-months in the TACM group (p=0.04). Technology-assisted case management by a nurse with medication titration under physician supervision was efficacious in improving diastolic blood pressure without compromising quality of life in low-income rural adults with diabetes. Disclosure L.E. Egede: None. R.G. Knapp: None. R.J. Walker: None. E. Garacci: None. J.S. Williams: None. Funding U.S. Department of Defense (W81XWH-10-2-0057)

Health care for chronic neurological patients after COVID-19.

Health care for chronic neurological patients after COVID-19.

Is Legal Really Legal?: The Evolving World of Cannabis.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney and managing partner of Muller & Muller with a Bachelor of Arts degree in Health Care Management from St. Peter's University of New Jersey. She earned her Juris Doctor from Quinnipiac University School of Law in Connecticut. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the Contributing Editor of the journal Professional Case Management. She is an adjunct professor at St. Peter's University School of Nursing in the MSN and DNP programs. Dr. Muller is the author of more than 50 articles in nursing and case management journals and was featured in the Journal of Nurse Administrators. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways, the author of the Legal & Ethical Chapter of the sixth edition of the Case and Population Health Chapter for Leadership and Nursing Case Management by Diane L. Huber, published by Elsevier. Dr. Muller is the author of both legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and third edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Manager Certification (CCMC), where she now serves on the Professional Development and Education Subcommittee, is a facilitator for the CMCC360 2-Day Immersion Program, and is a contributor to the CCMC Case Management Body of Knowledge (CMBOK). She is a past President of the New Jersey Chapter of CMSA and the former Director of Social Services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as a public defender, a municipal court judge, a councilwoman, and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected]. If you have an idea you would like to discuss, send your contact information by e-mail and you will be contacted via your preferred method. The author reports no conflicts of interest.

Case Management Demographics Reveal Insights Into Who Is Practicing Case Management Today.

Michelle Baker, BS, RN, CRRN, CCM, is the 2019–2020 Chair of Commission for Case Manager Certification. Michelle is also Associate Director, Network Services, for Paradigm Catastrophic Care Management. Her primary areas of focus include administrative management of workers' compensation catastrophic nurse case managers and program development/implementation and training of the clinical network. Michelle serves as a subject matter expert of relevant applications and leads preceptors in preparation of new case managers. MaryBeth Kurland, CAE, is CEO of the Commission for Case Manager Certification, the first and largest nationally accredited organization that certifies more than 48,000 professional case managers and 2,600 disability management specialists. Address correspondence to MaryBeth Kurland, CAE, Commission for Case Manager Certification, 1120 Route 73, Ste 200, Mount Laurel, NJ 08054 ([email protected]). The authors report no conflicts of interest.

A Geriatric Pharmacy Resident's Clinical and Educational Activities During Weekly interprofessional Team Meetings.

OBJECTIVES: To describe and gather further details about the clinical and educational activities that were documented by the geriatric pharmacist resident during both weekly interprofessional Acute Care for the Elderly (ACE) rounds as well as bedside patient counseling. DESIGN: Retrospective chart review (quality improvement project). SETTING: Inpatient geriatric service at University of Pittsburgh Medical Center (UPMC). PATIENTS: Medical learners selected one complex patient from the geriatric service for ACE rounds each week. ACTIVITIES: The geriatric pharmacist resident provided clinical information and medication education to the interprofessional team and to the patient and/or family at their bedside. Activities were documented in a newly developed template. MAIN OUTCOME MEASURES: Patient demographics, medication categories, discrepancies and dosing changes, time-in-rounds, and team members. RESULTS: De-identified data from 18 patients (72.2% female, average age 82.5 ± 9.18 years) over a 6-month period were collected and analyzed. The geriatric pharmacist resident provided most education to the team on antibiotics, antidepressants, over-thecounters (OTCs), and prescription pain medications during ACE rounds. They provided most education to the patient/family on prescription pain medications, antidepressants, OTCs, and anticoagulants. The pharmacist resident identified 38 medication discrepancies (72.2% of patients had ≥ 1 discrepancy, range 0-7) and clinically significant drug-drug interactions in 15 patients. The pharmacist resident recommended dosing changes in 12 patients and therapeutic alternatives in 11 patients. The ACE rounds lasted on average 26.6 [± 6.42] minutes and included medicine, pharmacy, social work, nurse case management, nursing, and nutrition and rehabilitative services when necessary. CONCLUSION: The results provide insight into both the clinical and educational activities of the geriatric pharmacist resident in support of interprofessional rounds.

Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer.

The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure.

Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks. To assess the cost-effectiveness of 3 types of postdischarge HF transitional care services and standard care. Decision analytic microsimulation model. Randomized controlled trials, clinical registries, cohort studies, Centers for Disease Control and Prevention life tables, Centers for Medicare & Medicaid Services data, and National Inpatient Sample (Healthcare Cost and Utilization Project) data. Patients with HF who were aged 75 years at hospital discharge. Lifetime. Health care sector. Disease management clinics, nurse home visits (NHVs), and nurse case management. Quality-adjusted life-years (QALYs), costs, net monetary benefits, and incremental cost-effectiveness ratios (ICERs). All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81327 vs. $76705), resulting in an ICER of $19570 per QALY gained. Results were largely insensitive to variations in in-hospital mortality, age at baseline, or costs of rehospitalization. Probabilistic sensitivity analysis confirmed that transitional care services were preferred over standard care in nearly all 10000 samples, at willingness-to-pay thresholds of $50000 or more per QALY gained. Transitional care service designs and implementations are heterogeneous, leading to uncertainty about intervention effectiveness and costs when applied in particular settings. In older patients with HF, transitional care services are economically attractive, with NHVs being the most cost-effective strategy in many situations. Transitional care services should become the standard of care for postdischarge management of patients with HF. Swiss National Science Foundation, Research Council of Norway, and an Intermountain-Stanford collaboration.

Case management nurse in Spain: facing the challenge of chronicity through a comprehensive practice.

A new type of nurse role was established in the Spanish health care system in the late 1990s, currently called case manager nurse, to ensure access to resources needed to cope with chronic conditions and comprehensive home care. This paper aims to present this figure and discuss aspects of its work. The methodology was based on the bibliographic review of papers and normative publications and interviews with primary health care nurses, nursing faculty, and case management nurses. We present a brief history of the implementation of the case manager nurse role and the conceptual and operational bases of her practice in three autonomous Spanish communities: Andalusia, Valencian Community, and Basque Country, discussing potentialities and issues concerning this practice. In the conclusions, we make some considerations on the possible implementation of the case manager nurse in the Brazilian health system.

Research Progress of Case Management and Evaluation of Quality of Life in Patients with Diabetes by Out-Patient Nurses

Diabetes is the world’s third largest threat to people’s health. In China, the incidence of diabetes is on the rise, the cure rate of diabetes is low, patients with complications are more, and diabetes patients bring a heavy economic burden to the family and society. Compared with developed countries, China still has a big gap in terms of diabetes care, education and management, and even less long-term follow-up of diabetes education and management results. Therefore, the management of diabetic patients should not only stay in the intervention during hospitalization, but also extend to the outside of the hospital. Only by implementing the whole-process nursing case management integrating hospitalization-family/community-outpatient, can diabetic patients better control blood glucose, delay or prevent the occurrence of chronic complications, and improve their quality of life. The nursing work method of case management is adopted to carry out personalized assessment for diabetes patients, design the process of initial outpatient consultation, content and process of follow-up consultation for nurses, and implement personalized guidance. The diabetic complications should be screened regularly, diabetes management should be standardized, self-care ability and behavior compliance of treatment and nursing of diabetic patients should be improved, and comprehensive whole-process nursing management should be provided for every diabetic patient, so as to improve the quality of life of patients and truly benefit diabetic patients.

Risk of hearing loss among multidrug-resistant tuberculosis patients according to cumulative aminoglycoside dose

SETTING: The ototoxic effects of aminoglycosides (AGs) lead to permanent hearing loss, which is one of the devastating consequences of multidrug-resistant tuberculosis (MDR-TB) treatment. As AG ototoxicity is dose-dependent, the impact of a surrogate measure of AG exposure on AG-induced hearing loss warrants close attention for settings with limited therapeutic drug monitoring.OBJECTIVE: To explore the prognostic impact of cumulative AG dose on AG ototoxicity in patients following initiation of AG-containing treatment for MDR-TB.DESIGN: This prospective cohort study was nested within an ongoing cluster-randomized trial of nurse case management intervention across 10 MDR-TB hospitals in South Africa.RESULTS: The adjusted hazard of AG regimen modification due to ototoxicity in the high-dose group (≥75 mg/kg/week) was 1.33 times higher than in the low-dose group (<75 mg/kg/week, 95%CI 1.09-1.64). The adjusted hazard of developing audiometric hearing loss was 1.34 times higher than in the low-dose group (95%CI 1.01-1.77). Pre-existing hearing loss (adjusted hazard ratio [aHR] 1.71, 95%CI 1.29-2.26) and age (aHR 1.16 per 10 years of age, 95%CI 1.01-1.33) were also associated with an increased risk of hearing loss.CONCLUSION: MDR-TB patients with high AG dose, advanced age and pre-existing hearing loss have a significantly higher risk of AG-induced hearing loss. Those at high risk may be candidates for more frequent monitoring or AG-sparing regimens.

Advancing Complex Case Management Competencies in a Health Care System.

The purpose of this literature review is to evaluate evidence to support advanced education for hospital-based nurse case managers to address the discharge needs of medically complex patients who have extended hospital stays. Acute care hospital and hospital systems. Studies on hospital length of stay are prevalent as are studies of effective case management and the importance of a comprehensive education program. Correlating effective case management to successful disposition of long-stay patients and efficacy of discharge planning education is the focus of this review of evidence. Creation of advanced case management competency education will benefit patients, staff, and the health care system by increasing the skill level to promote early recognition of discharge barriers in complex long-stay patients. Continued focus on affordability in health care will keep management of hospital length of stay high on the priority list. Pressure to create efficient patient management strategies leading to timely discharge disposition of medically complex patients through barrier mitigation and intervention requires effective case management tools.

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.

Nurse case management to improve the hepatitis C care continuum in HIV co-infection: Results of a randomized controlled trial.

The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges remain that negatively influence progress through the care continuum, particularly for persons co-infected with HIV who are not well engaged in care. We conducted a randomized controlled trial to test the effect of nurse case management (NCM) on the HCV continuum among adults co-infected with HIV compared to usual care (UC). Primary outcomes included linkage to HCV care (attendance at an HCV practice appointment within 60days) and time to direct-acting antiviral (DAA) initiation (censored at 6months). Sixty-eight participants were enrolled (NCM n=35; UC n=33). Participants were 81% Black/African American, 85% received Medicaid, 46% reported illicit drug use, 41% alcohol use, and 43% had an undetectable HIV viral load. At day 60, 47% of NCM participants linked to HCV care compared to 25% of UC participants (P=.031; 95% confidence bound for difference, 3.2%-40.9%). Few participants initiated DAAs (12% NCM; 25% UC). There was no significant difference in mean time to treatment initiation (NCM=86days; UC=110days; P=.192). Engagement in HCV care across the continuum was associated with drinking alcohol, knowing someone who cured HCV and having a higher CD4 cell count (P<.05). Our results support provision of NCM as a successful strategy to link persons co-infected with HIV to HCV care, but interventions should persist beyond linkage to care. Capitalizing on social networks, treatment pathways for patients who drink alcohol, and integrated substance use services may help improve the HCV care continuum.

Case Management for Southwestern Hospice Organization: Process Improvement Plan.

Studies have shown that registered nurses are inadequately prepared to care for patients requiring hospice and palliative care. Reasons include inadequate curriculum, along with a lack of structured education related to hospice/palliative care and symptom management, which includes inadequate education on delivering home-based hospice/palliative case management. Challenges at the Southwestern Hospice Organization are consistent with industry standards, evidenced by a high level of afterhours triage phone calls related to ineffective case management setup and delivery upon patient admission to hospice service. Many of these triage inquires could be prevented with improved registered nurse case management education and subsequent execution. Through analyzing Southwestern Hospice Organization afterhours triage phone data, a deficiency in effective patient case management setup and delivery was defined. Best practices in hospice/palliative case management were then identified, and a quality improvement plan in the form of a nurse driven, hands-on, home hospice/palliative case management simulation was generated. Quality improvement for patient case management at the Southwestern Hospice Organization was the end goal.

Developing Structured Omaha System Goals for Use in an Electronic Health Record.

Use of standardized terminology has been essential for clear, concise, and accurate documentation of client assessments, care plans, and outcomes. The purpose of this study was to create standardized language goals for a case management system that used the Omaha System. A group of nursing informaticists analyzed, refined, and developed revised goals evaluated using medical vocabulary properties. A set of unique goals aligned with the Omaha System was developed with specifically designed characteristics and functionality that allowed individualization and evaluation of goal attainment. Goal statements and ratings were standardized and written to reflect goals a client could attain. The Omaha System goals served as a template for nurse case managers to use in telephonic support with clients and future development of new goals and allowed the organization the ability to generate quality metrics.

Nursing case management for people with hypertension in primary health care: A randomized controlled trial.

Hypertension is a chronic disease that requires continuous and long-term care to prevent or delay the development of associated complications. Although various interventions for hypertension exist, case management in Brazil's primary healthcare is understudied. We examined nursing case management effectiveness for controlling blood pressure among Brazilian adults with hypertension in the public healthcare system. A randomized controlled trial with a 12-month follow-up was conducted at a primary healthcare clinic in southern Brazil. Adult patients with hypertension were randomly allocated to intervention (n = 47) and usual care groups (n = 47). The nursing case management model includes nursing consultations, telephone contact, home visits, health education, and appropriate referrals. Patient outcomes (blood pressure, body mass index, waist circumference, quality of life, treatment adherence) were assessed at baseline and 6- and 12-month follow-up for the intervention group and at baseline and 12-month follow-up for the usual care group. Data were collected from only the intervention group at T6 to avoid contact between the researcher and the usual care group, and to check the care plan and modify it if necessary. After the intervention, the intervention group's blood pressure decreased significantly compared to the usual care group. The differences in systolic and diastolic blood pressure between the groups was -8.3 (intervention)/1.1 (usual care) mmHg (p = .004) and -7.4/-0.6 mmHg (p = .007), respectively. The intervention group had significantly greater improvement in waist circumference (-2.0/1.2 cm), body mass index (- 0.4/0.3), and treatment adherence (4.8/-1.1) than the usual care group (all p < .05). Nursing case management in primary healthcare may be effective for improving outcomes among patients with hypertension.

Flying by the seat of their pants: A grounded theory of school nurse case management.

To develop a theory describing the processes and actions involved with school nurse case management for school-aged children with chronic conditions in the K12 system. Case management is an essential practice for the school nurse. Little is known about actual case management practice in real-world settings. Grounded theory methodology following a literature-based conceptual model of school nurse case management. A purposive maximum variation sampling was used for data collection and analysis. Semi-structured interviews conducted in-person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6months was also used to define a chronic condition. In all, 14 school nurses with an average of 12years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports. The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature. This article informs nursing leadership of the real-world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.