This practical, "hands-on" guide includes vital information every case manager and administrator of a case management program need to be successful. A useful resource for working in the changing face of healthcare, it addresses case managers in all settings with an emphasis on nurse case managers and their role in providing patient care and containing costs. Focusing on the "nuts and bolts" aspects of case management, it discusses the operations of case management programs based on the authors' first hand experiences.
- Case Management Tip boxes in each chapter highlight important tips and provide easy access to this information.
- Case studies in several chapters address possible situations the case manager may confront along with the most effective solutions.
- Key points at the end of each chapter summarize pertinent information.
- Appendices provide extensive examples of forms and multi-disciplinary action plans used in various healthcare settings.
- Six new chapters have been added on Utilization Management (Chapter 5), Transitional Planning (Chapter 6), Disease Management (Chapter 7), Application of Legal Concepts in Case Management Practice (Chapter 17), Ethical Issues in Case Management (Chapter 18), and Internet Resources and Case Management (Chapter 19).
- Content on Financial Reimbursement Systems has been expanded to cover community case management issues such as the new community reimbursement systems for ambulatory, home, and long-term care.
- Information on community-based models is covered in more detail in response to growth in this area — including managed care, telephonic, rehabilitation, sub-acute, and long-term and emergency department case management.
- The chapter on Skills for Successful Case Management has been expanded to include a discussion of additional skills such as clinical reasoning, cost-effectiveness, and negotiation among others.
- Content on Developing Case Management Plans has been updated to include more content on community plans and a detailed review of the types of case management plans, including algorithms.
- The chapter on Quality Patient Care has been updated to include an historical review, minimum data sets, report cards, and the relationships between outcomes and quality. Quality indicators and organizations across the continuum are included.
- Appendices have been expanded to include community-based case management plans, home care plans, and long term care plans.
1. Introduction to Case Management
2. Financial Reimbursement Systems
3. Case Management Models
4. Role of the Nurse Case Manager
5. Utilization Management
6. Transitional Planning
7. Disease Management
8. Skills for Successful Case Management
9. Nurse Case Manager's Documentation
10. Hiring Case Managers: Role of the Candidate and the Interviewer
11. Curricula and Certification in Nurse Case Management
12. Developing Case Management Plans
13. Quality Patient Care
14. Measuring the Effectiveness of a Case Management Model
15. Linking JCAHO to Case Management
16. Legal Issues in Case Management
17. Application of Legal Concepts to Case Management Practice
18. Ethical Issues in Case Management
19. Internet Resources and Case Management
A. Community Nurse Case Management Problem List and Plan of Care
B. Community Nurse Case Management Intervention Flow Sheet and Problem Rating Scale for Outcomes
C. Community-Based Wound Care Pathway and Flow Sheet
D. Home Care Plan for Congestive Heart Failure and Hypertension
E. Sub-Acute Care
E-1 Clinical Guideline for Short-Term
E-2 Referral Assessment Form
E-3 Sub-Acute Data Collection Tool
F. Long-Term Care Resident Assessment Instrument Case Study and Care Plans
G. Pre-Printed Order Sets
H. Documentation Guides for Physicians
I. Case Manager – Inpatient
J. Case Manager – Admitting Office
K. Case Manager – Emergency Department
L. Case Manager – Community
M. Physician Advisor
N. Guide for a Case Manager's Competency-Based Performance Appraisal
O. Performance Management Form – Case Coordinator