All Entries Tagged With: "patient advocacy"
AHRQ asks for comments about case management effectiveness
The Effective Health Care (EHC) Program, a division of the Agency for Healthcare Research and Quality (AHRQ), is preparing a research report on the effectiveness of case management for adults with medical illness and complex care needs. As part of the project, EHC has posted three key questions to its website that are available for public comment.
Answers to the questions will help researchers and experts tailor their research so it is as useful as possible and are as follows:
Question 1
In adults with medical illness and complex care needs, does case management* improve patient outcomes, including: overall quality of care; disease-specific quality of care; disease-specific health outcomes; quality of life; patient satisfaction with care; morbidity and mortality, compared with usual care or other models of case management?
- Does the effectiveness of case management for patient outcomes differ according to patient characteristics, such as: particular medical conditions; number or type of co-morbidities; patient age; patient SES; and/or level of formally assessed health risk?
- Does the effectiveness of case management for patient outcomes differ according to intervention characteristics, such as: particular practice or healthcare system setting; case manager experience or training; and/or particular case management skills, tools, techniques or information systems?
* A necessary condition for case management is the assignment of a single person, alone or in conjunction with a team, to coordinate all aspects of a patient’s care.
Question 2
In adults with medical illness and complex care needs, does case management improve resource utilization outcomes, including: overall financial cost; hospitalization rates; emergency department use; and number of clinic visits, compared with usual care or other models of case management?
- Does the effectiveness of case management for resource utilization outcomes differ according to patient characteristics, such as: particular medical conditions; number or type of co-morbidities; patient age; patient SES; and/or level of formally assessed health risk?
- Does the effectiveness of case management for resource utilization outcomes differ according to intervention characteristics, such as: particular practice or healthcare system setting; case manager experience or training; and/or particular case management skills, tools, techniques or information systems?
Question 3
In adults with medical illness and complex care needs, does case management improve process measure outcomes, including: adherence to therapy; missed appointments; patient self-management; health behavior change; disease-specific processes of care; and physician or case manager satisfaction, compared with usual care or other models of case management?
- Does the effectiveness of case management for process measure outcomes differ according to patient characteristics, such as: particular medical conditions; number or type of co-morbidities; patient age; patient SES; and/or level of formally assessed health risk?
- Does the effectiveness of case management for process measure outcomes differ according to intervention characteristics, such as: particular practice or healthcare system setting; case manager experience or training; and/or particular case management skills, tools, techniques or information systems?
To comment on the questions visit the AHRQ website. The deadline for comments is October 11.
Helping noncompliant patients cheat more effectively
Teaching noncompliant patients how to cheat seems counterproductive, but this strategy saved the lives of some members of one medical center’s renal patient population.
A large teaching hospital surveyed its renal patients and found that most didn’t adhere to their very restricted diet. Salt was the main culprit. Potassium rich foods came in a close second, and, unfortunately, street drugs were the third problem.
The case manager assigned to the renal patients worked closely with the nursing director and unit staff to create realistic diet goals.
They tackled the salt problem first. The team created five reduced-salt spice recipes and conducted a taste test. Each patient rated the spice concoctions from best to worst. Staff and physicians contributed money to buy the highest rated spices and gave them to the patients along with the recipes.
The team then took on potassium rich foods. First, the case manager ordered a dietary consultation to ensure that educational deficit wasn’t the problem. She then met with each patient who admitted to eating more potassium rich foods than allowed. They reached a compromise that allowed patients to have two of these foods weekly as long as it was two to four hours before dialysis and their physicians approved. The case manager knew that dialysis would help eliminate excess potassium and that cheating only twice weekly was far better than indulging daily.
The most telling conversations were with patients who had used illegal drugs. The issue was when they used them. Many patients had used them just prior to their dialysis treatments. This often caused the patients to go into full cardiac arrest during the procedure.
With the physicians’ consent, she spoke with these patients confidentially. She explained that using drugs prior to treatment was causing them to arrest while on the machine, and one day they might not be resuscitated back to life. She also told them the drugs were likely being dialyzed out, and that they were simply wasting their money.
She offered rehab as the first option, but the patients had refused rehab many times in the past. So she then engaged them in a reality discussion. She told the patients the worst times for them to use drugs. She couldn’t tell them the best time to get high—there is no good time—but identifying the worst times prevented future cardiac arrests for three patients. Reducing length of stay was a side benefit.
Case managers need be aware of what patients’ lives are like outside the four walls of the hospital. When the patient understands we are simply trying to help find a solution that will work, they will be more open to following a regime they can truly live by, hopefully for a long time.
Do case managers communicate effectively?
The case manager’s main goal is coordinating care and collaborating with other members of the healthcare team. It is doing what is right for the patient, in the right setting, and in the most cost efficient manner. These goals require that case managers communicate effectively with patients and the appropriate healthcare providers.
Case managers spend time getting to know patients personally and through their medical records. This holistic approach gives them a full picture of the patient.
Admission case managers at Jennie Edmundson Hospital collect patient history, identify fall risks, and conduct medication reconciliation. They also conduct the initial case management environmental assessment.
Case managers and social workers discuss patients’ current condition and plan for discharge during daily morning huddles. Social workers and case managers then proactively discuss patients’ discharge plans with their physicians. This meeting affirms that everyone, including patients and their families, understands what is happening. We also conduct interdisciplinary rounds, during which social workers and case managers discuss patients with a larger group, including:
- Physician advisors
- Unit nurses
- Physical and respiratory therapy staff members
- Dieticians
- Diabetic educators
- Wound care nurses
- Pharmacists
Bedside nurses and case managers sometimes overlook the importance of daily communication with each other. Encourage bedside nurses to seek out their units’ case manager(s) daily to discuss changes in patients’ conditions and discharge plans. Bedside nurse sometimes may be missing crucial information that a case manager and/or social worker may have obtained from the patient’s physician.
As case managers and social workers communicate with patients and/or their families with respect to discharge planning, we must ensure that bedside nurses are also key participants. Bedside nurses provide education and discharge instructions to patients, so they must have all necessary information.
My facility encourages this type of communication. Do your case managers and/or social workers communicate with physicians and bedside nurses on a regular basis?
Providing patient choice for post-acute care
The patient’s right to choose is one of the most basic patient rights. When it comes to discharge planning, Medicare rules require hospitals to involve the patient in the process. They also must give patients a choice between the available and appropriate post-acute services (e.g., home health agencies and skilled nursing facilities).
According to the Conditions of Participation for Hospitals in Section 482.43:
(7) The hospital, as part of the discharge planning process, must inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of posthospital care services and must, when possible, respect patient and family preferences when they are expressed.
The concept seems straightforward, but many readers have recently been asking for additional clarification on the following issues:
- Documenting that the hospital provided post-acute discharge options to the patient
- Whether to include options that are off-plan
- Whether it is necessary to give choices to patients that are admitted from a nursing home they are satisfied with
- Whether it is appropriate to advise a patient on which facility to choose
- How many options the hospital should provide
Jackie Birmingham, RN, MS, vice president of Curaspan Health Group and author of HCPro’s Discharge Planning Guide, answered two reader-submitted questions for the Case Management Weekly e-newsletter on the topic. The following are Birmingham’s responses:
Medicare helps beneficiaries understand level of care
In December 2009, CMS released an informative pamphlet for Medicare beneficiaries that explains how level of care determinations affect Medicare reimbursement.
The document, titled Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!, provides basic level of care information. The document uses common hospital scenarios to show the difference inpatient status and outpatient status and what that means to the patient’s wallet. The pamphlet also explains how level of care determination can affect the patient’s SNF coverage.
Beneficiaries also learn about their guaranteed rights and who they can contact if they have questions, concerns, or grievances.
The information may seem basic to most seasoned case managers, but it could be a useful educational tool for those who frequently explain level of care to patients.
ACMA conducts an Important Message from Medicare survey
The American Case Management Association (ACMA) Public Policy Committee surveyed nearly 400 case management professionals regarding the second notice of the Important Message (IM) from Medicare .
Based on the data, the key findings were as follows:
- The majority of respondents (84%) report that case management is responsible for issuing the second IM
- More than half the respondents (59%) report that 10 minutes or less are required to issue each IM
- More than 77% of respondents report that they track IM compliance
- Of those who track IM compliance 40% report a compliance rate between 76% and 100%
- Only 38% of respondents report increased numbers of appeals
- The majority report that less than 25% of patient appeals are successful
The ACMA questioned respondents about the need or benefit of the second IM. Respondents said patients and family do not like being asked to redo the same tasks and use phrases such as: annoyed, waste of time and paper, frustrated, and signing more papers, to express their dislike.
Other comments said patients and families sometimes abuse the IM regulation in order to gain enough time in the hospital to qualify for skilled nursing care.
According to the ACMA, the findings will be released to ACMA members and non-members who participated in the survey.
Read more about the survey at the ACMA Web site.
Hospital-SNF readmissions study results
Results of a nine-month HCPro transition of care study available now on CaseManagementMentor.com illustrate the efforts of hospitals and SNFs to improve transitions. The study authors interviewed 931 hospitals and SNFs, seeking to better understand the following:
- The barriers affecting transitions between settings
- The underlying causes of readmissions
- The number of readmissions due to patient non-compliance
- The frequency of medication changes for transitioning patients and the potential influence on readmissions
- The community-based solutions hospitals and SNFs are piloting to create safer transitions, reduce readmissions
Download the report here or use the link in the “Hospital-SNF Readmissions Study Results” box in the right-hand column.
Case Management Week is almost upon us
Case managers, next week is all about you. October 11-17, is National Case Management Week, which is your opportunity to spread awareness about what case managers do and how they improve healthcare across the continuum of care.
Several case management associations have released information that describes how you and your staff members can celebrate all things case management.
If you are looking for National Case Management Week posters, banners, and pins check out the American Case Management Association’s National Case Management Week catalog.
The Case Management Society of America (CMSA) put out a 20-page packet that is full of ways you can raise case management awareness:
- Individual activities
- Tell 10 other professionals you are a case manager.
- Offer to speak at community events on case management.
- Write letters to your local paper. Contact radio and TV stations to let them know about CM Week.
- Write a guest editorial to newspapers, journals or magazines regarding the positive impact of case management.
- Distribute a press release announcing National CM Week.
- Community activities
- Host a celebration or reception to recognize a case manager in your community.
- Host professional seminars and workshops for health professionals in your community.
- Arrange exhibits and displays in public facilities.
This is not an exhaustive list. See the full list of suggestions at the CMSA Web site
Please share your plans for National Case Management Week.
Guidance to ‘the most appropriate level of care’
Case managers serve as the patient’s advocate to promote safe, quality care during the patient’s stay in the hospital and after discharge. Sounds like the ideal job, right? For nurses who “live” the role, rather than “do” the job, it truly is. Grace’s story is one that conveys how complex, yet fulfilling living the role can be.
Grace read the physician’s orders for Diane to begin outpatient dialysis upon her return to her nursing home. Grace began looking for a dialysis center that would be close to Diane’s nursing home and had chairs available. However, the center that would accept Diane was quite a distance from the nursing home. If Grace were to receive treatment at the facility, she would need to be transported via ambulance three times each week for treatment. Unfortunately, this circumstance was not unusual, so Grace proceeded with making tentative arrangements.
When Grace entered Diane’s room to discuss her treatment, she saw Diane lying on her side. She was thin, drawn, and severely contracted with tunneling decubiti throughout her body. With the slightest movement, she cried out in pain. However she was alert, oriented and communicative. Throughout Grace’s long career as a case manager, she had symbolically seen Diane far too many times.
Grace approached Diane with a warm smile and a trusting, caring tone of voice. After explaining her reason for being there, Grace began to question Diane in order to determine her mental competency and ability to make decisions. After all, Grace was there to determine what Diane needed and wanted, not just to tell her to do what the physician had ordered. Grace sought Diane’s consent for the treatment plan. She explained the risks, benefits and alternatives of her plan for continuing dialysis as an outpatient. [more]
Can Twitter improve healthcare communication?
Twitter, the social network based around the phrase “What are you doing right now?”, continues to gain popularity in world of healthcare. But can it help improve communication with patients’ families?
Children’s Medical Center in Dallas thinks so.
The latest facility to “tweet” during surgery (a concept created in February by Henry Ford Health System), Children’s sees the technology as a way to help communication between physicians and families.
Read more about the idea here.
Do you use Twitter? Know anyone that does? Feel free to share your thoughts.
