Case Management

Case management is a collaborative process that involves assessing planning and coordinating care to meet the evolving needs of patients and their families.

The goals of case management vary depending on the health care setting and patient needs, but generally aim to develop a patient centered plan of care by helping patients manage their health care needs, navigate the healthcare system and achieve positive health outcomes.

As a nurse in case management, you'll identify patient needs and use available resources to organize and coordinate patient centered and cost effective care.

Nurses in case management, often called case managers have traditionally worked in public health, mental health and long term care settings, but also provide services in places like ambulatory clinics, assisted living communities, primary care offices and acute care settings.

Case managers receive training and certification to perform specialized skills and functions involving care management care, coordination and utilization review.

Care management is a strategy used to improve the health of specific groups of people by organizing services, avoiding duplication of care and encouraging self management of disease to lower health risks and reduce health care costs to do so.

Case managers identify patients and populations with modifiable health risks. Tailor services and education to meet their needs and ensure the right health professionals are able and available to provide care.

For instance, a case manager in a cardiology clinic will review electronic health records and identify patients who have been hospitalized more than once in the past year for exacerbations of heart failure.

Understanding that these patients are more likely to develop complications and be readmitted to the hospital. The case manager creates a protocol to reduce the likelihood of symptom exacerbation on a regular basis.

The case manager performs telephone check ins with at-risk patients asks them about their symptoms and barriers to disease management while assessing their need for additional services depending on the patients needs.

The case manager will schedule an appointment with the cardiology provider or coordinate care from another health care team member care.

Coordination is also a key part of the care management process and involves organizing patient care activities, staff and resources and ensuring there is effective communication between all members of the care team and the patient.

For example, patients with complex health care needs can have difficulty navigating the care provided by various providers at different settings.

Or communication between providers can be inefficient using care coordination strategies. The case manager can promote safe effective health care services by coordinating care across multiple settings including inpatient outpatient and community based providers and can serve as a point of contact for the families and providers to decrease fragmentation and duplication of care.

Now, case managers also use transitional care management to ensure patients safety, continuity of care and positive health outcomes as patients move from one level of care to another or one setting to another responsibilities of the case manager in this process can include reducing medication errors by performing medication reconciliation or the patient's current medications are compared with new prescriptions to screen for drug interactions and resolve discrepancies such as omitted medications or duplicate medications ordered in different forms or doses by different providers.

The case manager will also ensure a coordinated handoff process during patient transitions by updating the receiving team on the patient's care plan and providing an opportunity to ask questions, seek clarification regarding care and take over patient care more effectively when a patient is discharged home, the case manager may schedule follow up appointments and facilitate outpatient services to prevent readmission and support disease self management.

For example, if the patient is discharged home from the hospital after being newly diagnosed with diabetes, the case manager may call them to review their upcoming appointment schedule, discuss their discharge instructions and inquire about unmet needs.

Additionally, the case manager may refer the patient to other health professionals such as a diabetic educator or a podiatrist to prevent complications.

Finally, case managers perform utilization review activities to manage the allocation of health care resources. The necessity and appropriateness of medical services is evaluated to ensure patients receive the needed level of care to provide cost effective care and improve clinical outcomes.

For instance, if a patient is admitted to the hospital for pneumonia to receive intravenous antibiotics, the case manager can use screening tools to determine when the patient no longer meets hospitalization criteria and work with the health care team to plan for discharge.

The case manager will also ensure the patient receives necessary follow up care and resources such as prescriptions or home health services.

All right. As a quick recap, case management is a collaborative process that involves assessing planning and coordinating care to meet the evolving needs of patients and their families.

It aims to help patients manage their healthcare needs, navigate the healthcare system and achieve positive health outcomes.

Case managers work in a variety of settings and perform skills and functions related to care, management, care, coordination and utilization review.