Case Management and Collaboration

Answer

1. • Case Management and Inter-professional Collaboration

      

     Introduction

     The primary role of a nurse, according to the boards of nursing is to continuously assess how the patient responds to both the health problem and the prescribed treatment intervention, and accordingly act as the coordinator of health care delivery. This means that nurses play a pivotal role in influencing the efficiency and effectiveness of case management and inter-professional collaboration. Case management refers to the process that involves nurses bringing together members of different healthcare disciplines in a given health care delivery system as the healthcare team develops evidence-based plans to address the patients’ health needs. The success of these plans depends largely upon the collaboration and coordination among interdisciplinary teams that provide both the physical, psychological and spiritual aspects of the patient. Thus, meeting the patients’ healthcare needs calls for a collaborative approach where the nurse has the responsibility of coordinating and implementing nursing care plans and evidence-based interventions. This paper offers a discussion on how case management models can be used in practical clinical settings to enable health practitioners to deliver patient care while enhancing interprofessional collaboration. 

     Case Management Model

     The selected article for this discussion is “Improve the Quality of Your Case Management Department through Staffing, Part 1” by Toni Cesta. 

     Cesta points out that appropriate staffing of care case management departments has, for a long time, remained a major theme in many discourses surrounding effective care delivery. This is because one of the most overwhelming challenges in many healthcare settings concerns determining the required ratio of registered nurse case managers as well as that of social workers. In the past, registered nurses were responsible for utilization activities while social workers primarily performed the roles of discharge planning. Due to changing clinical landscape and increasing nursing workload, however, two fundamental models have been developed to assist case managers to plan, organize and assign their work. These models, according to Cesta (2017), are the Integrated Case Management model and the Collaborative case management model. However, this discussion focuses on the collaborative case management model.

      

     How the Collaborative Case management model can be used to Prioritize and enable care management in a real-World clinical setting. 

     The collaborative case management model, as the name suggests, includes three parties; namely the registered, social worker and the business associate or the utilization manager. The registered nurse performs the roles and functions involved in patient flow such as patient assessment and reassessment and creating care delivery plans, while the social worker is responsible for discharge planning. On the other hand, the utilization manager, as the third member, is tasked with improving clinical documentation and other aspects of the facility’s business operations including conducting regular clinical reviews for the purposes of billing by a third party (Cesta, 2017). This implies that the key role of a case manager in this model is to assess, plan and coordinate care delivery, while managing patient outcomes.       

     Case managers in many health care facilities in the U.S utilize the collaborative case management model as a tool for organizing and assigning work to different professionals in order to improve quality of care and promote patient outcomes. For instance, the Ontario Health Center in California seems to heavily rely on this model in most of its clinical operations. In particular, case managers at the facility use the model not only to plan and coordinate care delivery, but also to reduce operation costs. They also employ the model in fostering communication among all the practitioners and stakeholders involved in the diagnosis, treatment planning and other activities that are necessary to achieve the goals of optimum recovery of health and function” (Underwood, 2016 para line 5). These activities, as Kanter (2009) found out include patient engagement, assessment planning, patient psycho-education, collaboration with psychiatrists, family consultations, crisis intervention, and establishing linkage with resources. 

     Since the collaborative case management model focuses on all the facets of both the social and physical environment as evidenced in the aforementioned activities, the approach is of vital importance in promoting “continuity of care”, which is one of the key tenets of clinical case management. At the Ontario Health Center for instance, the model provides case managers and nurses with opportunities to offer long-term care and establish trusted relationships with patients to understand historical perspectives of their illnesses, while focusing on solutions to current health issues through innovative interventions (American Case Management Association, 2018). Additionally, according to Kanter (2009), it allows case managers at the facility to address the needs of patients with high relapse rates such as the mentally ill by deciding whether psychiatric consultation should be scheduled with the patients or supportive psychotherapies should be used to address the stressors. 

     Being a local healthcare center, Ontario Healthcare has a limited bed capacity of 59 beds (Ontario Health Center, 2018). Case managers, therefore, find the collaborative case management model quite resourceful when it comes to determining the patients to hospitalize, those to discharge and those to schedule appointment with respective practitioners such as physical therapists in therapy department. In this way, the model enables health professionals at the facility to prioritize and provide care that has continuity.     

     Role and Function of Interprofessional Collaboration.

     Ontario Health Center is a 59-bed healthcare facility that provide a wide range of care services ranging from reproductive health, HIV services, Primary Care, immunizations, maternal health, therapy services and 24/7 admissions (Department of Public Health Bernardino County, 2017; Ontario Health Center, 2018). This means that different professionals at the facility perform different roles and functions. For example, RN case managers coordinate patient flow activities such as diagnosis, admissions processing, HIV screening for adults and expecting mothers and scheduling appointment, while social workers are responsible patient counselling, rehabilitation and outpatient services such as speech, physical and occupational therapy. 

     These activities are supported by a business associate who handles the business or financial aspects of the case management process including upholding high medical integrity at the hospital, ensuring accurate documentation of patient information and remitting billing information to insurance carriers, Medicaid, Medicare and other thirty-party payers. Evidently, streamlining and harmonizing these varied roles and activities to improve patient care and satisfaction requires effective collaboration of the professionals involved in care delivery.         

     Interprofessional collaboration is centered on communication, cooperation and coordination. These factors have been identified as the three key competences that reduce errors and promote evidence-based practice among healthcare professionals (Jakubowski & Perron, 2018). As such, it is only through collaboration with other healthcare team members that registered nurses can deliver proper care aimed at improving patient outcomes such as reduced morbidity and mortality rates (Leape et al. 2009). Moreover, as Chang (2009) notes, interprofessional collaboration plays a key role in reducing workload among health care providers, thereby, increasing their job satisfaction and enhancing patient care.

     Furthermore, interprofessional collaboration offers nurses with opportunities to recognize and respect the expertise and responsibilities of other professionals that they are working with. It is this awareness that allows the nurses to communicate effectively with other professionals, build strong relationships with patients, and above all, plan and implement care plans for promoting patient outcomes (Jakubowski & Perron, 2018). This implies that the other essential role of interprofessional collaboration concerns communicating the roles and responsibilities of healthcare practitioners to patients, their families and other care professionals. At the Ontario Health Center for instance, practitioners in the maternal health department coordinate with those in the HIV services and reproductive health departments to ensure that all expectant mothers are screened for HIV. On the other hand, the admissions processing practitioners have to collaborate with the discharge planning staff to ensure that beds are available before admitting patients for hospitalization. 

     Other roles of interprofessional collaboration as outlined by Vega and Bernard (2017) include engaging diverse healthcare professionals to maximize their potential in working towards meeting patients’ specific care needs and clarifying the responsibility and function of every practitioner in the healthcare team. Lastly, it also helps in harnessing the knowledge, abilities and skills of professionals from different disciplines in order to provide evidence-based care that is effective, safe and affordable for patients.