NURSE CASE MANAGEMENT

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NURSE CASE MANAGEMENT

• A
• PUBLIC HEALTH MODEL
• Infectious Disease
• October 2005

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Introduction
Introduction

• Case Management model designed for use in
• population approach
• community setting
• complex clients (disease management)

Leane Els Glenyse Hargraves Professional
Leader Public Health Nurse Public Health Nurse
Auckland Regional Public Health Service
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Nurse case management - a strategy for care
co-ordination
A role and process that focuses on procuring,
negotiating, and coordinating the care, services,
and resources needed by individuals with complex
issues throughout an episode or continuum
Bower, K. (1996)
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Case Management goals

• Enhance health status and functionality of
  clients
• Maximise client access to services
• Use resources cost-effectively
• Integrate coordinate services provided by
  multiple disciplines

Cohen (1996)
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Five Principles of nurse case Management

• Focuses on clients and families with complex
  issues
• Involves negotiation, coordinating, and
  procuring services and resources
• Entails using a clinical reasoning process
• Network development of multi-disciplinary
  relationships
• Is episode- or continuum-focused

Cohen, E (1996)
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Hospital
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Sanatorium
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Community
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Nurse case management in the Community Setting

• Health promotion disease prevention
• Prevent escalation of client condition
• Comprehensive collaborative care
• Efficient use of health care services
• Practice guidelines, clinical pathways
  client/family outcomes improve effectivity

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The Case Management Process

• Case finding risk appraisal
• Nursing interventions matched against
  characteristics needs of the risk group
• Co-ordination of services continuum of care
• Evaluation of individual group outcomes
• Bower, K. (1992) Mullahy, C.M. (1995)

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WIDER COMMUNITY
NURSE
WORK PLAY
WHANAU
CLIENT
HOSPITAL
MOS/PHMS
OTHER PHNS
SOCIAL AGENCIES
NURSE
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Strengths

• Good collaboration
• nurse/client/doctors/services
• Focuses on prevention
• Highlights health promotion
• Treatment becomes an integral part of daily life
  for our client

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Weaknesses

• Dependent upon individual nurses
  skills/perseverance/initiative
• Educational requirements vs the demands of the
  role
• Nurses often feel ill-prepared to offer basic
  instruction/support in health promotion
  prevention

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Optimum Example
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NURSE CASE MANAGEMENT (2)

• A
• PUBLIC HEALTH MODEL
• Infectious Disease
• October 2005

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Benefits Outcomes

• Question
• Where on the continuum do the clients access
  services?
• How do we measure prevention?
• How do we measure health promotion?
• What changes are needed to realise these
  benefits?

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Why measure outcomes?

• Dramatic shifts in health care delivery is being
  driven by changes in reimbursement
• It is more cost effective to treat populations by
  using epidemiological and public health models
  rather than treating individuals or
  families/whanau

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Challenges in Measuring Outcomes

• Client confidentiality
• I.T. development of user friendly software
• Nurses need to adapt health care practice to
  modern-day technology
• Population-based care requires healthcare
  providers work together

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Examples of Outcomes Measurement

• Quality Outcomes
• Cost Outcomes
• Comparison studies to show contrast
• Measuring the complexity of needs

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Lessons Learned

• Central to this model are
• Collaboration
• Networking
• Keeping the client family/whanau at the centre
  of care
• Public health nurses have become pro-active in
  the development of strategies that are core to
  the health care management of high-risk
  populations eg. Case management
• Multi-disciplinary team approaches
• National and International planning

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Bibliography

• Bower, K. and C. Falk (1996). Case Management as
  a Response to Quality, Cost, and Access
  Imperatives. Nurse Case Management in the 21st
  Century. E. Cohen. St. Louis, Mosby 161-166.
• Cohen, E. (1996). Nurse Case Management in the
  21st Century. St Louis, Mosby.
• Cohen, E. and T. Cesta (1997). Nursing Case
  Management from concept to evaluation. St Louis,
  Mosby.
• Donabedian, A. (1990). The Seven Pillars of
  Quality. Arch Pathol Lab Med 114 1115 - 8.
• Etheredge, M. L. (1989). Collaborative Care
  Nursing Case Management. (American Hospital
  Association), American Hospital Publishing, Inc.
• Kersbergen, A. L. (1996). Case Management a
  rich history of coordinating care to control
  costs. Nursing Outlook 44(4) 169-72.
• Zander, K. (1990). Patient Care Delivery Models.
  Rockville, MD Aspen Publishers.

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• He aha te mea nui ki te Ao?
• He tangata,
• he tangata,
• he tangata

• What is the most
• important treasure on
• earth?
• It is people
• It is people
• It is people