Case management practice is not a new concept and has been around in some form since the early 1900s. It has changed dramatically over the years without much research to prove the value and return on investment. The Case Management Society of America (CMSA) has developed a comprehensive definition of case management and Standards of Practice, (SoP16); however, these guidelines have not been globally adopted by the healthcare industry. There are many models of case management practice, but unfortunately there is no theoretical framework to demonstrate the effectiveness of the models or their interventions. Developing evidence-based practice (EVBP) interventions within models of care management is essential to improved quality of care and patient outcomes by decreasing fragmented care, implementing successful transition of care and focusing on patient values and preferences.
Healthcare reimbursement is ever-changing, and the system continues to demand quality care, cost containment and positive outcomes. These objectives often fall under the responsibility of the case manager who “assesses, plans, facilitates, coordinates care transition and patient advocacy” in a collaborative effort with the patient, their support systems, and the healthcare team (SoP, 2016).
More research is needed that demonstrates the value and effectiveness of case management. For this reason, it is important for case managers to gain knowledge of how using EVBP empowers them to use effective tools and interventions to validate return on investment. Case managers need to understand how to access resources to develop process improvement and research programs. Process improvement projects and research promote improved quality of care within our own practice and the healthcare system.
We all know of Florence Nightingale, but did you know that she was an English social reformer and statistician? She revolutionized nursing through her evidence-based research. The title of her landmark observational study is “Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army” during the Crimean War. She documented the importance of sanitary living conditions and improved hygiene for the English soldiers during the war (1850s), resulting in a significant decrease in mortality for the soldiers in a short period of time. She made rounds every night to offer comfort and peace to her soldiers. Her fundamental nursing theory of person, environment and health are still relevant today throughout nursing education.
How do you define EVBP? Evidence-based practice is composed of information from several different sources. It may start with the case manager’s cumulative experience and education since case managers have excellent skill sets. Clinically relevant research is accessed that was conducted with sound methodology. The information should be derived from a well-done systematic review taken from multiple studies identified through a literature search. It is also important to include the patient’s values, preferences, and unique concerns. Treatment expectations and goals should always be discussed with the patient.
As case managers, we are always exploring and analyzing areas where there may be process improvement opportunities. A process improvement plan formally documents a strategy for improving or making things better. To create a basic process improvement plan, identify an area that can benefit from a change in strategy or process. The purpose of the study should be clearly defined. The plan should be presented to the leadership team and institutional rules, including the roles of participating staff, must be agreed upon and adhered to. An action plan is developed and implemented. The outcome of the review will then be measured and evaluated and re-evaluated, leading to a new and improved process.
There are many areas of health that have shown improved patient outcomes through process improvement studies. Some examples include transition of care planning, prevention of overutilization of resources, case management productivity and compliance with state and federal quality measures. The CMSA Integrated Case Management Model (CMSA ICM) uses a numeric scoring methodology to stratify patients according to complexity across all domains of health. This model simplified the ability to create an award-winning research project demonstrating a decrease in emergency department visits and hospitalizations for a group of Medicaid recipients. Patient satisfaction and quality of care surveys are commonly used within hospitals, managed care organizations, state and federal agencies and provider practices. Improving patients’ healthcare experiences helps organizations work toward Quadruple Aim goals and financial return.
The CMSA Foundation is a charitable, not for profit organization created to support education, research and professional development for case management professionals. It was founded “by case managers for case managers.” The Foundation envisions a better future for the case management industry through a collaborative, inclusive community of healthcare professions working together to build industry-wide solutions to case management issues. Through our donors, we were able to offer a scholarship for the CMSA ICM training and a Margaret Leonard Public Policy Grant. The Public Policy Grant was created with the intent to raise visibility and public awareness of the professional case management practice. This year we were able to provide scholarships for conference registration that included a one-year CMSA membership due to the generosity of our donors.
The CMSA Foundation’s Case Management Practice Improvement Award/ Case Management Research Award recognizes individuals, groups or organizations that use findings from a research or quality/performance improvement (QI/PI) initiative for innovation in the advancement of case management practice and/or improved client outcomes. We encourage you to submit your application for our 2021 awards. For more information and to meet the winners of this year’s awards, please review our website at www.cmsafoundation.org for additional information and read the articles from the 2019 award winners.
As case managers and healthcare providers, we are dedicated to helping patients from all walks of life “one person at a time.” Let us not forget how the review of aggregated data is critical to move forward with process improvement and research leading to improved patient outcomes. Case managers are essential front- line workers counseling and coordinating care during these unsettling times. We are all heroes.
, RN, CCM, is a well-known leader in the field of case management and a winner of the esteemed National CMSA Award of Service Excellence. Sheilah practiced as a registered nurse specializing in critical care and has over 25 years of case management experience. As a senior director at Hudson Health Plan, her innovative programs focusing on underserved populations have won awards at local, state and national levels. She has held various leadership positions within the HV Chapter including past president and is currently serving as vice president. She has been a proud CMSA Foundation board member for 2 years. Sheilah is presently sharing her expertise by working as a case manager educator focusing on the basics of MI, CMSA Standards of Practice, leadership, and implementation of the Integrated Case Management Model.
, BSN, RN, CCM, recently retired from Lincoln Financial Group, where she was a clinical research specialist and nurse case manager in the commercial disability arena. She has practiced in a variety of settings in her 30+ years as a nurse, with 25 of those years in case management. She is active in her local chapter, served on numerous committees at the national level and is the current secretary of the CMSA Foundation.
REFERENCES
- Case Management Society of America (2016). Standards of Practice for Case Management
- Case Management Society of America. (2019). The Practice of Hospital Case Management white paper
- CMSA Foundation. www.cmsafoundation.org
- Coordinated Behavioral Care, Inc. 2016. Pathway Home™.
- Florence Nightingale. https://www.britannica.com/biography/Florence-Nightingale
- Fraser, K., Perez, R., & LaTour, C. (2018). CMSA’s Integrated Case Management – A Manual for Case Managers by Case Managers. Springer Publishing Company.
- Zehr, K. 2018. Case Study: Triad Case Management Model Applying Human Performance Technology
