ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The implementation of the case management model and the use of critical pathways has become a major strategy to Improve quality of care and cope with measuring and managing costs. Grant Medical Center, a 640-bed Level I Trauma Center, began case managing its chronic ventilator patients in July, 1993. A 30-day critical pathway was developed using a multidisclplinary team approach. In case managing these patients, many problematic Issues were identified, such as lack of adequate Involvement by staff experienced in specific disciplines and multiple physician decision makers for each case. By increasing multidisclplinary collaboration, care of these patients was systematically changed and streamlined. Over a 2-year period, the average length of stay for chronic ventilator patients decreased from 74.5 days to 41.9 days, and the average cost per case decreased from $189,080 to $107,019.

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

When healthcare executives speak of managed care, they often use the term generlcally to refer to any arrangement with a healthcare payer other than traditional fee-for-service relmbursement. All too often, the “management” aspect is missing from managed care, resulting in an arrangement that could more aptly be described as “discounted care.” This lack of clinical representation is unfortunate, since there are numerous issues that have an impact on clinical care, including choice of referral providers, noncoverage of certain procedures or treatments, and similar issues that may influence the patient's plan of care. Organizations that approach managed care as a system that blends the resources of management, finance, and clinicians, will enjoy the greatest potential for success. With their practical experience and insight into the administrative and clinical issues that may be encountered, nurse case managers will ultimately be responsible for managing the care of the contracted population. As case managers are the vital link among payers, providers, patients, and families, it is essential that the case manager understand managed care concepts, be conversant in the terminology of managed care, function as a member of the team responsible for evaluating contracts, and periodically review existing arrangements. This article presents an overview of the managed care contract development process, and provides tools to enable the nurse case manager to participate in the contracting process.

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

As managed care continues to emerge as a dominant structure for delivering and reimbursing health care, nursing is responding and assisting in reshaping the health care system. Nursing case management as a new delivery of care includes providing and coordinating care across the continuum. The continuum includes prevention, wellness, acute, rehabilitation, long term, and hospice care. Various definitions of case management exist and are dependent on the discipline that employs them, the setting in which they are implemented, and the personnel and staff mix used in their implementation. Patient identification, assessment, planning, implementing and coordinating and evaluating the delivery of service and patient outcomes are components common to all cose management models. The nurse case manager should be minimally educationally prepared at the baccalaureate level. She/he should also have expert clinical skills, knowledge of the health care system, health care finances, and legal issues and be an effective communicator. Within the case management model the case manager will use various tools to achieve clinical, quality, and economic outcomes. Some of these tools include practice guidelines, critical paths, variance analysis, protocols/algorithms, risk assessment, and outcome measurement tools.

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Regardless of the setting, the role of the nurse as a manager of care continues to grow and develop. The nurse case manager needs to have vital information readily available to facilitate critical thinking, analysis, and decision-making on the appropriateness of care provided to patients and to ensure that optimal outcomes are achieved. While there are a variety of clinical information systems available, it is evident that the complexity of the case manager's information needs presents challenges for software developers. Accordingly, nurse case managers must take an active role in defining and communicating their needs. The purpose of this article (the first of two) is to present a general overview of the information needs of the nurse case manager and the computerized information system tools available (and emerging) to meet these needs. A follow-up article in the next issue of Nursing Case Management will focus on a typical clinical information system selection process; outline specific ways the nurse case manager can effectively influence that process; and provide a checklist that will enable the nurse case manager to assist the institution in selecting and implementing the most appropriate system.

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Timely management of variances is vital for cost effective patient care. A multifaceted approach that involves the healthcare team, patient, and family facilitates the identification and management of variances as they occur. The critical path can be used to monitor variances that influence fiscal outcomes in select patient populations. Strategies are described that can be used to monitor and manage variances, inducing developing a mechanism for monitoring and managing variances, implementing that mechanism, and evaluating the process for usability. Monitoring variances includes choosing tools that will be used and staff who will assume primary responsibility, and initiating an outcome analysis program. Managing variances comprises organizing an inter-disciplinary committee, establishing a communication plan, creating strategies, and using continuous quality improvement teams.

ISSN:1084-3647    

出版商:OVID    

年代:1996

数据来源: OVID