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At least 433 records · Page 24Linked to original sources
PubMed2003

Managing managed care through accreditation standards.

Accreditation is emerging as a dominant strategy for ensuring accountability and basic quality of services in managed care organizations. Knowledge of accreditation standards can help social workers interact effectively with managed care companies when requesting services for clients and appealing denials. Familiarity with patient's rights protections, the appeals process, and provider credentialing guidelines can help protect social workers as well as clients from unfair decisions by managed care organizations. This article provides an overview of managed care accreditation standards and strategies for integrating this knowledge into advocacy efforts.

Accreditation↗
PubMed1999

Blending case management and quality outcomes management into the family nurse practitioner role.

As health care reform moves into a new millennium, the importance of comprehensive case management and quality outcomes management still has not brought about the cost-effective quality of care that was hoped. The purpose of this article is to explore further the potential impact that the family nurse practitioner as a primary care provider might have on case management and the management of quality outcomes of care.

Case Management↗
PubMed2001

Environmental management of asthma at Massachusetts managed care organizations.

Asthma management staff at eight Massachusetts managed care organizations (MCOs) were interviewed to learn the extent of inclusion of environmental prevention strategies in their asthma disease management policies. Six of the plans had formal asthma disease management programs, all reported to be based on the National Heart Lung and Blood Institute guidelines, but none followed these guidelines in their entirety. Three MCOs provided for home visits that included addressing environmental factors for severe asthmatics. Despite the limited role that MCOs appear to play in environmental prevention of asthma, the authors identify opportunities and encourage efforts to expand these programs.

Adult↗
PubMedDate not supplied

Global case management: using the case management model for the care of patients with acute myocardial infarction in a military hospital in Turkey.

This study was planned in an experimental manner to use the "case management model" for the care of patients with acute myocardial infarction (MI), and to determine the effect of this method on the quality of care, patient and nurse satisfaction, and the patient's inpatient duration at the hospital. Data for the study were obtained using the Patient Information Form, Acute MI Care Protocol (Clinical Pathway), Care Monitoring Scale and Scoring Form, Acute MI Nursing Care Plan, Patient Education Booklet, and a Patient and Nurse Satisfaction Evaluation Survey. Evaluation results showed that the patient group where the case management model was used had increased quality of care, decreased inpatient stay, and increased satisfaction of the patient and the nurse. Therefore, it was suggested that the case management model be used in healthcare institutions in Turkey, care protocols for various diagnoses be developed, and nurses should be trained as case managers to increase the quality of care at healthcare institutions.

Case Management↗
PubMedDate not supplied

A system that works: managing managed care in psychiatry.

The Carrier Foundation, a not-for-profit psychiatric facility in Belle Mead, NJ, has been working with managed care for the past 5 years. As managed care began to affect patients' access to care, the quality improvement department at The Carrier Foundation became involved in case management. Through case management, the quality improvement department began to provide guidance to private review organizations to preserve and protect patients' rights and to ensure accurate reporting of clinical data.

Concurrent Review↗
PubMed2005

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual.

BACKGROUND: All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal circumstances may become maladaptive in a crisis. It was judged in a previous study that the use of a structured "core" algorithm (based on the mnemonic COVER ABCD-A SWIFT CHECK) would diagnose and correct the problem in 60% of cases and provide a functional diagnosis in virtually all of the remaining 40%. It was recommended that specific sub-algorithms be developed for managing the problems underlying the remaining 40% of crises and assembled in an easy-to-use manual. Sub-algorithms were therefore developed for these problems so that they could be checked for applicability and validity against the first 4000 anaesthesia incidents reported to the Australian Incident Monitoring Study (AIMS). METHODS: The need for 24 specific sub-algorithms was identified. Teams of practising anaesthetists were assembled and sets of incidents relevant to each sub-algorithm were identified from the first 4000 reported to AIMS. Based largely on successful strategies identified in these reports, a set of 24 specific sub-algorithms was developed for trial against the 4000 AIMS reports and assembled into an easy-to-use manual. A process was developed for applying each component of the core algorithm COVER at one of four levels (scan-check-alert/ready-emergency) according to the degree of perceived urgency, and incorporated into the manual. The manual was disseminated at a World Congress and feedback was obtained. RESULTS: Each of the 24 specific crisis management sub-algorithms was tested against the relevant incidents among the first 4000 reported to AIMS and compared with the actual management by the anaesthetist at the time. It was judged that, if the core algorithm had been correctly applied, the appropriate sub-algorithm would have been resolved better and/or faster in one in eight of all incidents, and would have been unlikely to have caused harm to any patient. The descriptions of the validation of each of the 24 sub-algorithms constitute the remaining 24 papers in this set. Feedback from five meetings each attended by 60-100 anaesthetists was then collated and is included. CONCLUSION: The 24 sub-algorithms developed form the basis for developing a rational evidence-based approach to crisis management during anaesthesia. The COVER component has been found to be satisfactory in real life resuscitation situations and the sub-algorithms have been used successfully for several years. It would now be desirable for carefully designed simulator based studies, using naive trainees at the start of their training, to systematically examine the merits and demerits of various aspects of the sub-algorithms. It would seem prudent that these sub-algorithms be regarded, for the moment, as decision aids to support and back up clinicians' natural responses to a crisis when all is not progressing as expected.

Algorithms↗
PubMed1991

Problems with managed psychiatric care without a psychiatrist-manager.

Seven critical cases in which patients at major psychiatric risk received less than adequate managed care are presented. Five patients committed suicide, one patient progressed to psychosis, and one became permanently physically disabled. In all seven cases, the patient's care was managed by a non-psychiatrist--by a bachelor's-level therapist or case manager in three cases and a family physician, a cardiologist, a nurse, and a master's-level social worker in the other four cases. In the cases in which psychiatric consultation was sought, psychiatrists, either in the managed care setting or outside it, were used mainly as psychopharmacological consultants. In three cases, their recommendations were not followed or were poorly implemented. In six cases, mismanagement of psychotropic medications was a factor in the fatal or serious outcome.

Adolescent↗
PubMed2000

Indicator-based systems of performance management in the National Health Service: a comparison of the perceptions of local- and national-level managers.

Historically, the UK Government has policed the use of National Health Service (NHS) resources through the centralization of control. With the majority of resource-draining decisions being taken by clinicians, however, professional financial accountability is becoming more important within the NHS management structure. Variations in clinical performance can be monitored through the use of performance indicators, although these are not without their problems. The use of league tables of such indicators in the national press is now infamous and there is much anecdotal evidence about the intraorganizational conflict arising from the use of such tables. A questionnaire survey and interview study of clinical directors, clinical service directors and business managers in several Scottish NHS Trusts was undertaken to ascertain the perceptions of local-level managers on the issue of performance indicators. Interviews were also carried out with a number of personnel in the Scottish Office Department of Economics and Information, the Division of Health Gain and the Finance Directorate. This paper explores the differences between the perceptions of the managers at these two levels of the NHS with regards to issues of performance measurement, intraorganizational conflict and corporate vision.

Administrative Personnel↗
PubMed2006

Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program.

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.

Asthma↗
PubMed2000

Management of multiple sclerosis across managed care and fee-for-service systems.

OBJECTIVE: To measure and compare care for adults with MS across managed care and fee-for-service (FFS) health systems. METHODS: The authors sampled adults with MS having physician visits over a 2-year period from a group model health maintenance organization (HMO) in southern California, from a midwestern independent practice association (IPA) model managed care plan, and from the FFS portion of the practices of a random sample of southern California neurologists. The authors mailed surveys to subjects in mid-1996; 930 of 1,164 (80%) of those eligible responded. The authors measured sociodemographic and clinical characteristics, management of recent changes in mobility, bladder control, and fatigue, use of a disease-modifying agent, assessment of general health symptoms and issues, and unmet information needs. The authors adjusted comparisons between systems for comorbidity, disease severity, and disease type. RESULTS: The groups differed on most sociodemographic and clinical characteristics. There were few differences in symptom management; differences that did exist tended toward more referrals or treatment for the FFS group. Access to the disease-modifying agent available at the time of the survey did not differ across systems, although patients' perceptions of the rationale for not using the drug did vary. General health issues and symptoms were more often assessed in the FFS and IPA systems than in the HMO, but improvement was needed across all three systems of care. There were substantial unmet information needs in all groups and especially high ones in the FFS and HMO samples. CONCLUSIONS: Strategies to improve care for people with MS should be developed and evaluated, particularly in areas like symptom assessment and meeting patient information needs. Where variations in service delivery exist, longitudinal studies are also needed to evaluate the potential impact on outcomes and to evaluate reasons for variation.

Activities of Daily Living↗
PubMed2005

The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings?

UNLABELLED: Inadequate analgesia in hospitalized patients prompted the Joint Commission on Accreditation of Healthcare Organizations in 2001 to introduce standards that require pain assessment and treatment. In response, many institutions implemented treatment guided by patient reports of pain intensity indexed with a numerical scale. Patient safety associated with treatment of pain guided by a numerical pain treatment algorithm (NPTA) has not been examined. We reviewed patient satisfaction with pain control and opioid-related adverse drug reactions before and after implementation of our NPTA. Patient satisfaction with pain management, measured on a 1-5 scale, significantly improved from 4.13 to 4.38 (P < 0.001) after implementation of an NPTA. The incidence of opioid over sedation adverse drug reactions per 100,000 inpatient hospital days increased from 11.0 pre-NPTA to 24.5 post-NPTA (P < 0.001). Of these patients, 94% had a documented decrease in their level of consciousness preceding the event. Although there was an improvement in patient satisfaction, we experienced a more than two-fold increase in the incidence of opioid over sedation adverse drug reactions in our hospital after the implementation of NPTA. Most adverse drug reactions were preceded by a documented decrease in the patient's level of consciousness, which emphasizes the importance of clinical assessment in managing pain. IMPLICATIONS: Although patient satisfaction with pain management has significantly improved since the adoption of pain management standards, adverse drug reactions have more than doubled. For the treatment of pain to be safe and effective, we must consider more than just a one-dimensional numerical assessment of pain.

Adult↗
PubMed2006

Clinical impact of a pharmacist-managed diabetes mellitus drug therapy management service.

STUDY OBJECTIVE: To evaluate the impact of clinical pharmacist interventions, including drug therapy management, on outcomes relevant to diabetes mellitus. DESIGN: Retrospective chart review. SETTING: Ambulatory, multispecialty physician group practice within a managed care environment in suburban Chicago, Illinois. PATIENTS: Three hundred sixteen patients aged 18 years or older, with a diagnosis of diabetes mellitus (89% with type 2), who were referred to a clinical pharmacy service. INTERVENTION: Drug therapy management and education service provided by a clinical pharmacist. MEASUREMENTS AND MAIN RESULTS: Data were collected for glycosylated hemoglobin A(1c) (A1C), blood pressure, and low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride concentrations. Data also were collected regarding patient adherence with American Diabetes Association guidelines for preventive care, including annual eye and foot examinations, influenza shots, and daily aspirin use at both baseline and follow-up. Mean +/- SD A1C reduction was 1.4% +/- 1.94% (p<0.001); the percentage of patients whose A1C was at goal level at baseline (< 7%) increased from 14.8% to 43.2% (p<0.001). Mean +/- SD LDL level reduction was 14 +/- 41.1 mg/dl (p=0.002), mean +/- SD triglyceride level reduction 42 +/- 97.6 mg/dl (p<0.001). The percentage of patients who reached goal for LDL level (< 100 mg /dl), HDL level (> 40 mg/dl), and blood pressure (< 130/80 mm Hg) did not increase significantly from baseline, whereas those who reached the triglyceride level goal (< 150 mg/dl) increased from 36% to 55% (p<0.005). Frequency of annual dilated retinal examinations and monofilament foot examinations increased by 29% (p<0.05) and 12.5% (p<0.05), respectively. Daily aspirin use increased from 35% to 59% (p<0.05). CONCLUSION: Significant clinical improvement occurred in patients referred to the pharmacist in a diabetes drug therapy management program.

Aged↗
PubMed2002

Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

Case Management↗
PubMedDate not supplied

Financial management for nurse managers--the bottom line for renewal.

Cost-effective health care has become the hospital motto for the 1990s. A great majority of costs can be controlled on individual nursing units, but many clinically expert nurse managers lack skills in financial management. Our goal was to teach such skills in a framework in which cost was balanced with quality. The three-day course emphasized leadership skills and management styles, change and renewal, solutions to problems of nurse turnover, and specific financial strategies. Evaluations of the course were positive and demonstrated one way in which valuable nurse managers can learn new skills to keep up with current needs.

Cost-Benefit Analysis↗
PubMed1991

Risk management, safety management, and quality assurance.

The changes that have taken place in health care during the past few years have also created changes in our hospital safety programs. We can no longer address the safety issue as a dual function of a department manager. The safety management program plays an important role in the overall success of the quality of the facility. Safety is no longer a program that stands alone and oversees the fire safety program. To have a successful risk management and quality assurance program, safety management has to be included as an integral part.

Hospital Administration↗
PubMed1992

Management ... practice Manager.

Carole Green became a Practice Manager because she wanted to influence directly what was happening and to see the results of her work; she was the first GMTS I management trainee to work in general practice. Her job combines the roles of business manager, company secretary, contracts negotiator, marketing manager and -- at times -- general factotum.

Administrative Personnel↗
PubMed1984

Information resources management: management focus on the value of information and information work.

Progressive management views information resources--all forms of stored data; people as information sources, processors and communicators; information tools--as major assets of companies in the information age. They treat and manage information resources as other valuable resources, e.g. personnel, finances, energy. The unique characteristics of managing information resources are introduced. Approaches toward the introduction of information resources management are outlined.

Information Systems↗