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A social work practice model of case management: the case management grid.

Case management is a major component of the current mainstream of social work practice. Nevertheless, the field has failed to adequately conceptualize case management. The first step in defining case management practice is to separate it from the administrative structure that forms the context of practice. The next step is to delineate the two basic dimensions of case management--enabling and facilitating. The role of the social work case manager is to integrate formal systems of care with the activities of families and primary groups. Case management practice focuses on enabling individuals and primary groups to reach their full potential and on facilitating more effective interaction with the larger social environment. The case management grid illustrates how social work practitioners integrate enabling and facilitating into their practice approaches.

Humans

The managerial nature of case management.

Case managers have been viewed as engaging in direct practice, community practice, or both. This article offers a third view: Case managers also engage in the practice of management. Employing Mintzberg's seminal research on chief executive behavior, the authors argue that case managers' work is similarly characterized by brevity, variety, and fragmentation. Case managers perform the 10 roles developed in Mintzberg's original study. These roles are divided into three groups: interpersonal, including figurehead, leader, and liaison; informational, including monitor, disseminator, and spokesperson; and decision-making, including entrepreneur, disturbance handler, resource allocator, and negotiator. Case managers' tasks associated with each role are presented. Considering their work as managerial in nature will help case managers more effectively assist clients in goal achievement.

Health Resources

Defining case management.

Case management is a frequently used term in nursing; however, it is not easily defined. The discussion that follows examines the various meanings of case management and the roles of the case manager.

Humans

Adolescent pregnancy and early intervention programs benefit from case management.

Case Management methods are being adapted to effectively serve two vulnerable populations: pregnant and parenting adolescents, and infants and toddlers with disabilities of developmental delay and their families. This article describes the case management model developed by California's Adolescent Family Life program and discusses issues related to providing family-centered, community-based case management in early intervention programs.

Adolescent

A decentralized model for case management.

Case management has been implemented in a variety of health care settings. The implementation of case management at one hospital, including rationale for selection and outcomes, is described here. A decentralized model emphasizing staff nurse control is recommended for hospitals with TQM and shared governance programs already in place.

Decision Making, Organizational

The role of the clinical nurse specialist and the nurse manager in case management.

Nursing case management was introduced into the acute care hospital as an approach to counteract the numerous changes occurring in the healthcare environment negatively affecting patient care. The authors address the development of case management at Bergan Mercy Medical Center, Omaha, Nebraska, and the integration of the nurse manager and clinical nurse specialist into this model.

Hospital Information Systems

Case management: a case study.

Prior to institution of case management Mr. G would have remained on the neuroscience acute care unit until nursing home placement could be arranged, a process which often took a year because of the severe shortage of Medicaid beds in South Carolina. Because case managers collaborated to identify and resolve the problem, the outcome for those such as Mr. G has changed. Case management facilitates movement of patients with complex problems from acute care to successful community reentry in a cost-effective manner.

Adult

Research issues in case management.

Case management and managed care are strategies for co-ordinating the services and care required by groups of patients in a variety of clinical areas. These systems have been described and discussed in a previous issue of Nursing Standard (1) which highlighted the fact that evidence used to support the effectiveness of these systems is currently very weak. The purpose of this article is to discuss some of the research and evaluation issues.

Health Services Research

An investigation of managed health care case managers.

Managed care case management is a relatively new concept within health and rehabilitation. As such, it lacks both definition and profiles of those providing services. This paper constructs a definition of managed care case management and presents the detailed results of a survey that identified the characteristics of case managers in the Midwest. The survey was mailed to 250 subjects. The respondents of the survey (N = 56) were relatively young (the largest number of respondents were 30 to 39 years of age), relatively new to their jobs (means = 2.2 years), and were typically employed full-time. They primarily served mental health (n = 43) and physically impaired (n = 30) clients. The highest number of their service referrals were made to vocational rehabilitation specialists, social workers, occupational therapists, nurses, and physical therapists.

Administrative Personnel

Case management with the nurse manager in the role of case manager in an interventional cardiology unit.

Varying external and internal factors are motivating changes in how physicians and nurses deliver patient care within health-care institutions. A care delivery system that has received increasing attention in the literature is case management. This chapter describes how a community hospital implemented case management for patients undergoing percutaneous coronary angioplasty and cardiac catheterization while developing the new role of clinical manager to serve in the role of case manager. The process for planning and implementing such a role change is discussed, and initial evaluative data are presented.

Angioplasty, Balloon, Coronary

Implementing managed care and case management: the neuroscience experience.

The case management model for patient care in the neuroscience area was recently implemented in the neurosciences area at a tertiary care hospital. Understanding of the concepts of case management and managed care were essential to the implementation process. Clustering of case types and appointment of group leaders made the development of individual care maps a manageable task. Case management of 2 case types, Parkinson's disease and Guillain Barré syndrome are described, including the rationale for selection, care map development and education. The process of continuing education focused on operational issues regarding utilization of the map and professional issues such as health teaching responsibilities.

Cost Control

The nature of case manager support.

Case managers have been assigned a key role in community support systems (CSS) for deinstitutionalized chronic mental patients, yet little research has been published on how case managers actually work with clients. In separate intensive interviews the authors questioned 30 CSS clients and their 15 case managers about how the case managers helped or failed to help clients with their daily functioning. Results are discussed in terms of the case managers' general role, and their role in linking clients to activities, providing social support, and preventing rehospitalization. The findings suggest that the case managers, by focusing on management of reality rather than on symptomatology, foster their clients' community adjustment.

Community Mental Health Services

Managed care and case management of substance abuse treatment.

Managed care has become an important subject for health service research and is used increasingly by health care payers to control health care use and costs. Health services research on managed care has relevance to the evaluation of case management of persons with substance abuse problems. Two issues in managed care that are particularly relevant to case management are the lack of explicit, widely accepted criteria for managed care and the lack of demonstrated cost savings attributable to managed care. Thorough, systematic evaluative research needs to be done before these issues are well understood.

Cost Savings

Outcome of home care for technology-dependent children: success of an independent, community-based case management model.

Case management is important for successful home care of technology-dependent, respiratory-disabled children. Traditionally, the medical model of hospital-based home care and case management has been used for these children. The outcome may be different from when using independent, community-based home care and case management. We evaluated the results of 28 technology-dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, community-based, case management group to coordinate home care. After 26.3 +/- 20.6 months of follow-up, 13 children (46%) remained technology-dependent, 10 (36%) were technology-independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community-based home care and case management is a reasonable alternative to the hospital-based model.

Abnormalities, Multiple

A new role for neuroscience nurses: the case manager.

Nurse case managers are becoming more visible within the nursing profession. Practice settings range from acute care to independent companies developed for the purpose of case management. In each area, the development of a more autonomous nurse is emphasized. Neuroscience nurses are particularly suited for the role of case manager since their patients often require extensive rehabilitation and nursing care. As patients face earlier discharges, neuroscience case managers will be the link to vital resources in what is now an often fragmented system of care.

Forms and Records Control

A graphic tool for tracking variance & comorbidities in cardiac surgery case management.

Nursing case management has been documented as one solution to the balance of cost and quality issues in healthcare. A current focus in healthcare is continuous quality improvement (CQI). CQI methods are focused on outcome measurements. Outcome research is a recent development in case management. Tracking variance, evaluating cost reduction and patient effectiveness, and determining types of patients at risk for negative variance are current case management research demands. Tracking patient comorbidities would allow for additional subset "tailoring" of existing critical pathways for specific comorbidities. Little research has been done on these issues. Few systems exist that track both variance and comorbidities. This article presents a graphic, simple, multidisciplinary tracking system that includes comorbidities and allows for individual and group patient variance analysis.

Aged

Comparing work satisfaction in two case management models.

Case management by professional nurses is expanding rapidly in managed care systems, but little is known about the quality of working life of nurse case managers (NCMs). This study explores the relationships among control over nursing practice, job stress and work satisfaction among NCMs and compares NCMs in a "within-the-walls" model with those in a "beyond-the-walls" model of nursing case management. Results of this small descriptive study suggest that NCMs perceived a relatively high degree of control over their practice and work satisfaction as well as a relatively low degree of job stress.

Burnout, Professional