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PubMed1992

Managing the maze: case management and service delivery.

The author discusses case management as the most recent social work effort to make manageable the pluralistic and proliferating array of human services. She notes that social work now claims case management as part of its long defined territory. The ability to make this function work is based upon an educational curriculum which prepares the professional in both direct interventive skills and management capability. Problematically, social work education usually provides the student with only one or the other sets of professional preparation. The importance of the power dimension must be acknowledged and honed if the case manager is to be successful working within a chaotic social service delivery system.

Humans↗

PubMed2004

Factors influencing the use of behavioral management techniques during child management by dentists.

Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques.

Adolescent↗

PubMed2005

Effect of psychological management techniques on specific item score change during the management of dental fear in children.

The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). However, no statistically significant dijfference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009).

Adolescent↗

PubMed2003

Integrating medical management with diabetes self-management training: a randomized control trial of the Diabetes Outpatient Intensive Treatment program.

OBJECTIVE: This study evaluated the Diabetes Outpatient Intensive Treatment (DOIT) program, a multiday group education and skills training experience combined with daily medical management, followed by case management over 6 months. Using a randomized control design, the study explored how DOIT affected glycemic control and self-care behaviors over a short term. The impact of two additional factors on clinical outcomes were also examined (frequency of case management contacts and whether or not insulin was started during the program). RESEARCH DESIGN AND METHODS: Patients with type 1 and type 2 diabetes in poor glycemic control (A1c >8.5%) were randomly assigned to DOIT or a second condition, entitled EDUPOST, which was standard diabetes care with the addition of quarterly educational mailings. A total of 167 patients (78 EDUPOST, 89 DOIT) completed all baseline measures, including A1c and a questionnaire assessing diabetes-related self-care behaviors. At 6 months, 117 patients (52 EDUPOST, 65 DOIT) returned to complete a follow-up A1c and the identical self-care questionnaire. RESULTS: At follow-up, DOIT evidenced a significantly greater drop in A1c than EDUPOST. DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents (ACFC) of food compared with EDUPOST patients. An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients. Also, the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes. The addition of insulin did not appear to be a significant contributor to glycemic change. CONCLUSIONS: DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors. However, it demands significant time, commitment, and careful coordination with many health care professionals. The role of the nurse case manager in providing ongoing follow-up contact seems important.

Adult↗

PubMed2006

[Effects of biophysical index, knowledge, and self management compliance of patients with primary hypertension by a self management compliance promotion program].

PURPOSE: This study was to develop and prove the effects of a self management compliance promotion program for primary hypertension patients who reside in rural communities. METHOD: The content of the self management compliance promotion program developed by this study was as follows: A leader trains patients as a group or individually, in walking, education and green tea therapy from the first to twelfth week. From the thirteenth to twenty fourth week, the patients should perform walking and green tea therapy by themselves. One hundred twenty subjects volunteered to participate in the study, who were among those registered as hypertension patients in the 14 community health clinics located in Chungcheongbuk-do. RESULT: Systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglyceride, step width, and degree of obesity decreased significantly. High-density lipoprotein cholesterol, step length, knowledge of hypertension, and self management compliance significantly increased. CONCLUSION: A self management compliance promotion program for primary hypertensive patients enhances biophysical index and knowledge on hypertension, thus ultimately suggesting a nursing intervention for promoting self management compliance.

Adult↗

PubMed1990

Top management program: management development in New Zealand's health services.

This article describes New Zealand's program for developing managers in health services, called the National Management Development Program (NMDP), run by a newly established unit of the Department of Health. This is a set of programs for training various groups of individuals in health administration: those with no experience who wish to enter the field, those in a particular area of health, and those who are already managers in the health field. The Top Management Program, designed for professionals already heading health agencies, offers continuing education as a sustained approach to improving individual management ability.

Education, Continuing↗

PubMed1993

Total quality management: a matter of quality polarity analysis and management.

Alvin Zander claims that group members are often more concerned with personal needs and rights than those of the organization. People tend to have their attention on only half (the upside of their preferred pole and the downside of the other) of the whole "picture" of a polarity. By making a complete, accurate diagram of the entire polarity and continually updating and using it, people can promote collaboration and effectiveness despite the automatic tendency for people to be both blind to the entire situation and individualistically undermining successful management of the polarity over time. In other words, most efforts to produce noteworthy and lasting results in successful implementation of total quality management most likely will be limited--or result in failure--due to the fact that nursing managers, staff, and administrators view autocratic management and employee empowerment as separate choices to be made and are unclear that their day-to-day action impacts both direction and empowerment continually. Polarity analysis and management tend to integrate what appear to be personal and individual needs with those of others in a collaborative partnership. When addressing any polarity, it is important to acknowledge that people at all levels of the organization potentially are paradoxically the greatest resources and the biggest barriers to unprecedented breakthrough results. Overzealous action to reduce autocratic leadership will subsequently affect empowerment negatively and thus ultimately erode direction. Likewise overzealous action to increase empowerment will promote a lack of focus and finally erode organization and compliance. As any group of people begins to experience the recurrence of the ups and downs of both poles, there is increased frustration, resignation, and sense of ineffectiveness.

Choice Behavior↗

PubMed1996

Managing diversity: a senior management perspective.

Diversity and managing diverse workgroups have become strategic imperatives for many organizations. Corporations are developing programs and opportunities to increase the participation of their employees, especially those who have not been previously included in the mainstream of their organizations. Many health care institutions are also focusing on diversity management. This study was designed to examine the manner in which diversity management is perceived and implemented by hospital executives. To determine the perception of executives, a 16-item questionnaire was developed and distributed to hospital executives. The data showed that executives in urban teaching hospitals considered their workforce diverse, and many of these organizations had implemented diversity management programs in their facilities. Surprisingly, this study found that although most executives (68 percent) agreed they had a diverse workforce, less than one-third (30 percent) of these executives had specifically developed diversity management programs in their hospitals.

Attitude of Health Personnel↗

PubMedDate not supplied

Installing management by objectives in a public agency: a comparison of Black and White managers, supervisors, and professionals.

This paper explores the prediction of King and Bass (1974) that black managers and supervisors may be more reluctant than whites to accept management programs such as management by objectives. Data were collected from 77 black and 61 white managers and professionals of the City of Detroit transportation system (D-DOT), after they had been involved with MBO for almost one year. Analyses of t-test results indicate that blacks assessed MBO as more helpful in their individual jobs and more positive for the organization than their white counterparts. Explanations derived from the racial demographics of the organization, the MBO installation, and characteristics of MBO as a management process in public agencies are given.

Administrative Personnel↗

PubMed2002

Managing for river health--integrating watercourse management, environmental water requirements and community participation.

The Mid North Rivers Management Planning Project (MNRMPP) of the Environment Protection Agency, Department for Environment and Heritage began as a response to community concerns regarding watercourse related issues in the Mid North of South Australia. In response to these concerns the MNRMPP project team developed rapid, cost effective methods to collect and assess data, establish collaborative partnerships with stakeholder organisations, ensure community involvement, and initiate mechanisms to sustain local involvement past the life of the project. Environmental water requirements were identified, along with key watercourse management issues; the integration of these two components of the study enabled more informed decision making regarding watercourse management within the study area. The integration of these components and the involvement of the community and stakeholders through all components of the project has resulted in a sense of ownership and an increase in awareness of watercourse related issues. This has increased the prospect of individuals and organisations implementing the management options and priorities identified within the plan, and has promoted the long term involvement of these groups in better watercourse management.

Community-Institutional Relations↗

PubMed1992

Case management: managing financial and clinical outcomes in ophthalmic nursing.

Case management is emerging in nursing as an effective and cost efficient model of care delivery for patients with complex nursing, medical, and psychosocial needs. The term "case management" first appeared in the social welfare literature in the early seventies and then later appeared in nursing literature (ANA, 1988). Nursing's concept of case management has been defined and interpreted to fit various health care settings. The purpose of this paper is to address a case management model and demonstrate through a case study how the case management model benefits the patient, the health care team, and the health care agency.

Adult↗

PubMedDate not supplied

The diagnosis and management of sinusitis in children. Surgical management: an otolaryngologist's perspective.

Sinusitis is more common in children than frequently recognized. Proper medical and surgical management will result in a lessened incidence of complications, better management of certain coexisting medical conditions, and improved quality of life for the child. Medical therapy usually is effective in managing individual occurrences. However, surgical management is indicated in children not responding to therapy, in those with threatened or existing complications and in those with frequent recurrences despite aggressive medical management. The intranasal antrostomy procedure performed via the inferior meatus is a procedure that has great benefit and is underutilized.

Age Factors↗

PubMed1997

Evidence-based, cost-effective risk stratification and management after myocardial infarction. California Cardiology Working Group on Post-MI Management.

Current management of patients after an acute myocardial infarction (AMI) reflects a variety of approaches ranging from conservative to aggressive. Although each method is appropriate in certain subgroups, their application frequently lacks a scientific basis. Current, clinically relevant, evidence-based practice guidelines are needed for secondary prevention for survivors after an AMI. To meet this need, the California Cardiology Working Group was assembled to evaluate the available data from clinical trials and other published studies and develop evidence-based, cost-effective guidelines for clinicians to use as a basis for patient management after an AMI. The group consisted of 18 members, including cardiologists from academic institutions and physicians working in cardiac intensive care, private practices, and managed care settings, representing a broad spectrum of expertise pertaining to patients who have had an AMI. The members had expertise in cardiac intensive care, interventional cardiology, nuclear cardiology, lipid disorders, echocardiography, and cardiac rehabilitation. The intended audience for these practice guidelines includes all physicians who treat survivors of MI. A literature review of all relevant clinical trials and other published data about the natural history after AMI and the effects of current therapeutic modalities are discussed herein. Case histories served as models for application of the literature-based data. The recommendations for management were reached by consensus vote based on the scientific evidence. When more than 1 management option applied, this was recognized in the recommendations. The recommendations accompany the text.

Arrhythmias, Cardiac↗

PubMed1999

Quality management practices in Medicaid managed care: a national survey of Medicaid and commercial health plans participating in the Medicaid program.

CONTEXT: Rapid expansion of Medicaid managed care has raised concerns about the capacity and willingness of health plans enrolling Medicaid beneficiaries to provide high-quality care. Recently, legislation has facilitated market entry of Medicaid plans, health plans that draw most of their enrollment from the Medicaid population. OBJECTIVE: To characterize and compare the organizational characteristics and programs related to quality of care of commercial and Medicaid health plans that participate in the Medicaid program. DESIGN: Cross-sectional survey conducted September 1997 to April 1998. SETTING: The Medicaid program in 11 states and the District of Columbia. PARTICIPANTS: All 154 health plans in these localities that provided prepaid general medical care to Medicaid beneficiaries during June 1997, of which 130 (84%) responded to the survey. MAIN OUTCOME MEASURES: Health plan reports of structural characteristics, services offered, performance measurement and feedback, disease management programs, information systems capabilities, and provider network composition and relationships. RESULTS: Half of the respondents were Medicaid plans, with 75% or more of enrollees drawn from the Medicaid population. Medicaid plans tended to be smaller and newer than commercial plans that also served the Medicaid population and had more enabling programs targeting the special needs of the Medicaid population, such as inadequate transportation (85% of Medicaid plans vs 62% of commercial plans; P = .003) and illiteracy (66% vs 38%, respectively; P = .002). Overall, 71% of Medicaid plans vs 43% of commercial plans had enabling programs targeted at 6 or more of the 8 special needs we specified (P = .001). While commercial plans had a higher proportion of board-certified primary care physicians (81% vs 73%; P = .01), we found no major differences between Medicaid plans and commercial plans in collection and dissemination of performance measures, designation of specific areas for quality improvement, or use of disease management programs targeted at conditions prevalent in the Medicaid population. Neither commercial nor Medicaid plans reported high success in improving quality of care. CONCLUSIONS: Based on our survey, while Medicaid plans resemble commercial plans serving the Medicaid population in many aspects of quality management, they are more likely to target programs directed to the specific needs of the Medicaid population. Neither commercial nor Medicaid plans have notably strong records in actual quality improvement.

Certification↗

PubMed1991

Managing loss adjustment expenses: strategies for health care risk managers.

Like most businesses, adjusting companies are not charitable organizations. They are entitled to a reasonable profit, which the risk manager should not begrudge. As a buyer of adjusting services, a risk manager with an inordinate obsession with slashing adjusting bills can destroy the goal of high-quality service. It is best for risk managers to pick and choose the areas for cutting adjusting expenses. To an extent, health care risk managers should view payment of high-quality adjusting services as an investment, with the payback being money saved by fighting fraudulent, exaggerated, and questionable claims.

Financial Management, Hospital↗

PubMed1998

Designing a system for managing the performance of mental health managed care: an example from New York State's prepaid mental health plan.

The organization, financing, and delivery of publicly funded behavioral health services are undergoing massive changes nationwide. Managed care principles and practices are being implemented widely and are being relied on increasingly to meet the challenges of containing costs and improving service effectiveness. To meet these goals, comprehensive systems are under development for measuring and reporting outcomes experienced by individuals who received services and for assessing the impact of managed care strategies on the service delivery system. This article presents an example from the Prepaid Mental Health Program in New York State. It highlights the development, implementation, and early experiences with the plan's performance management system for public sector managed behavioral health, a basis for continuous quality improvement activities and information reporting products such as report cards. Policy, administrative, and financial implications are illuminated.

Humans↗

PubMed2006

Managed care organizations' use of treatment management strategies for outpatient mental health care.

A nationally representative sample of managed care organizations was surveyed (response rate=92%) regarding use of treatment management techniques for outpatient mental health care in their commercial products in 1999. Bivariate tests and logistic regression models were used to examine the relationship between product type, behavioral health contracting arrangement and treatment management techniques (prior authorization, standards for time to initial appointment, concurrent review, standards for follow-up after discharge, case management, practice guidelines). Prevalence varied from 43% to 87% depending on the technique. HMO products and products with specialty behavioral health contracts were more likely to use the techniques. Product type and contracting arrangement had independent effects.

Ambulatory Care↗

PubMedDate not supplied

Linking the power of information technology and case management interventions: an assessment of recent medical-management trends.

Imagine a case manager screening a large employer group of 20,000 participants and within less than a couple of minutes: Your first reaction may be one of disbelief. You might think, "Yes, maybe in 2020." However, the reality is that this type of information exchange in the context of case management (CM) is happening today, and it is revolutionizing the medical-management system as we once knew it. This article highlights some of the key changes that have recently occurred in the medical-management field and that are creating a paradigm shift in how CM services will be rendered in the future.

Case Management↗