Nursing Case Management: From Essentials to Advanced Practice Applications

Hardcover: 640 pages
ISBN 0323027652
978-0323027656
Mosby
August 2004
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This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success.

This classic resource offers complete coverage of nursing case management - from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include:

the impact of public policy on health care;
understanding the effects of health care reimbursement and its application at the patient level;
throughput and capacity management;
the impact of the revenue cycle;
compliance and regulatory issues; and
principles needed to improve case manager-client interaction.

This helpful resource is designed to help nurse case managers by arming them with numerous benchmarks, resources and ideas. The plans here are concrete:

Includes numerous proven case management models currently being used in institutions across the country
Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program
Offers detailed guidance for planning, implementing, and evaluating a case management program
Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships
Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues
Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice
Presents acute care and community based models of case management
Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care
Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level
Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities
A new chapter, Telehealth Applications for Case Management, introduces the concept of telehealth; provides examples of telehealth usage in women's health, chronic disease management, and mental health; and summarizes the evidence that supports telehealth and identifies existing issues and challenges.
Case Management: Life at the Intersection of Margin and Mission, is a new chapter that highlights strategies case managers and others can use to optimize their organizations' financial outcomes while simultaneously improving clinical outcomes for their patients. It emphasizes the work of case managers in the financial arena of health care, including revenue cycle management.
A new chapter, Maximizing Reimbursement through Accurate Documentation and Coding, provides tips and strategies on maximizing reimbursement by designing and implementing programs focused on improving the physician's documentation.
New chapter that discusses strategy maps and balanced scorecards and their role in transforming an organization's mission and strategy into a management system and a comprehensive set of performance measures.
Features updated information on HIPPA regulation (Health Insurance Portability and Accountability Act), patient safety and confidentiality issues, case management for Medicare patients, Medicare legislation, and utilization management.

1	Evolution of nursing case management in a changing health care system	3
2	Historical perspective of nursing care delivery models within the hospital setting	12
3	Historical development of case management	18
4	Dimensions of nursing case management	27
5	Two strategies for managing care : care management and case management	33
6	Disease management : applying systems thinking to quality patient care delivery	38
7	Within-the-walls case management : an acute care-based nursing case management model	55
8	Collaborative models of case management	79
9	Case management : a process, not a person	87
10	The University of Colorado hospital psychiatric service health case management model : an innovative approach to client-centered care	97
11	Beyond-the-walls case management	125
12	Outcomes of community-based nurse case management programs	129
13	Integrated case management model	141
14	A faculty case management practice based in a college of nursing	157
15	A model of emergency department case management : developing strategies and outcomes	166
16	Patient demographics affecting health care	181
17	The business of health care and the prospective payment system	188
18	Patient mix and cost related to length of hospital stay	196
19	Case management legislation : national attempts to provide efficient health care	204
20	The managed care market : nurse case management as a strategy for success	210
21	Financing health care in the United States : economic and policy implications	219
22	Public policy and community-based case management : the nurse-family partnership	227
23	Assessing the system and creating an environment for change	241
24	Case management education : preparing for successful implementation	250
25	The competency outcomes and performance assessment model applied to nursing case management systems	263
26	The role of the nurse case manager	277
27	Credentialing for case management : licensure, certification, certificate programs, and accreditation	296
28	Facilitating educational and career mobility : online case management	311
29	The cast of characters	325
30	Variations within clinical settings	332
31	Brainstorming : development of the multidisciplinary action plan	339
32	Interdisciplinary care planning and documentation using nursing interventions and nursing outcomes classifications	352
33	Ethical issues in case management	361
34	Case management and information technology	380
35	Telehealth applications for case management	384
36	Compliance and regulation	397
37	Key functions and direct outcomes of case management	415
38	Case management : life at the intersection of margin and mission	423
39	Maximizing reimbursement through accurate documentation and coding	433
40	The data-driven health care environment : methods of gathering and presenting relevant data about health care systems	444
41	The importance of research in the evaluation process	462
42	Documentation of quality care	468
43	The link between continuous quality improvement and case management	477
44	Job satisfaction	487
45	Nurse case manager job characteristics and effects on well-being	494
46	Measuring cost-effectiveness	513
47	Case management evaluation: the use of the cost-effectiveness analysis method	523
48	Linking the restructuring of nursing care with outcomes : conceptualizing the effects of nursing case management using measurement and logic models	548
49	An overview of assessing health through quality of life indicators	560
50	Effective management tools for case management leaders : strategy maps and balanced scorecards, a case study	566
51	Outcomes effectiveness and evidence-based practice	572
52	The Carondelet community-based nurse case management program : yesterday, today & tomorrow	580

Elaine Cohen, RN, EdD, Director of Case Management University Hospital, University of Colorado Health Sciences Center, Denver, CO;

Toni Cesta, PhD, RN, Director of Case Management St. Vincents Hospital and Medical Center, New York, NY --This text refers to an out of print or unavailable edition of this title.

(information from the publisher)

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