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case management; chronic care management

An approach to patient care attempting to improve the technical quality of services that may decrease overall utilization of health care services. * - Goals: a) to provide quality care at least cost b) to reduce waste, redundancy, length of stay, cost c) to coordinated care pathways, practice guidelines, assessment & care planning, MDS/RAPs/RUGs, outcome measures d) to ensure integration with other levels in the healthcare system to produce seamless movement of the patient through the system e) implementation may increase revenue for the work being done [1] * - Types: a) internal: employee(s) of facility - assess potential admissions - facilitates care on the unit - interfaces with external managers b) external - case managers associated with outside organizations contracting with the facility Notes: - nursing-led case management (including medication adjustment) may lead to modest improvements in surrogate outcomes for diabetes mellitus (HgbA1c), chronic hypertension & hyperlipidemia (LDL cholesterol) [3] - Center for Medicare & Medicaid Services (CMS) provides reimbursement - there are billing codes that can be used by primary care providers in outpatient, assisted living, home, & nursing home settings for time communicating with patients outside the office - billing can be done by physicians or nonphysician practitioners & their clinical staff - patients qualify for CCM if they have 2 or more chronic conditions expected to last at least 1 year or result in risk of death, decompensation or functional decline - the billing organization must have - electronic medical record (EMR) - a team that provides - continuity of care - care planning/management - transitional care management - coordination of services, 24/7 access - availability for enhanced communication (such as via patient portal in an EMR)

Related

Care Management Plus

Specific

chronic care management program Collaborative care model community-acquired pneumonia assessment COPD assessed management of inflammatory bowel disease management of major depression

General

clinical process

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Smith, R. Jewish Home for the Aging, Reseda CA, 2001
  3. Shaw RJ et al Effects of Nurse-Managed Protocols in the Outpatient Management of Adults With Chronic Conditions: A Systematic Review and Meta- analysis. Ann Intern Med. 2014;161(2):113-121 PMID: 25023250 http://annals.org/article.aspx?articleid=1887028 - Jauhar S and Battinelli D Are Nurses an Answer to New Primary Care Needs? Ann Intern Med. 2014;161(2):153-154. PMID: 25023254 http://annals.org/article.aspx?articleid=1887036