After reading the chapters in this book, the
learner will be able to:
- Determine if case management is a new model
for the delivery of patient care.
- Discuss the evolvement of case management.
- Explain why the coordination of public
services was set up.
- Recognize what the community service focus
- Discuss why the United States Public health
Service designed an early case management system.
- Identify the act that made funds available in
the mid 1930s for the provision of meeting individual client health care needs.
- Name the movement that had a major impact on
the refinement of case management.
- Recognize when the term 'case management"
first emerged in social welfare literature and practice.
- Relate why Diagnosis Related Groups (DRGs)
were set up.
- Explain what form of nursing case management
emerged in the mid 1980s to deal with restraints imposed by DRGs and third party
payer resource conservation requirements.
- Discern whether managed care is a new
- Discuss what DRGs were designed to do.
- Explain what the initial focus of the
insurance industry was in the mid 1980s.
- Define capitation.
- Identify what the focus of health care is
- Discuss how health care institutions survive.
- Relate how the cost for technology is paid
- Compare lengths of stay with patient
- Determine how duplication and fragmentation
of health care services are influenced by the changing health care delivery
system of the 1990s.
- Recognize what the viability of health care
institutions relies on.
- Report what health care administrators have
to do with finite resources in a limited reimbursement climate.
- Define the goal of third party payer managed
- Discuss what a primary care physician in a
Health Maintenance Organization (HMO) is frequently charged with.
- List the five HMO models.
- Summarize the Individual Practice Associations' (IPAs) policy on reimbursement for health care services performed by non-member providers.
- Report why physicians and health care facilitators enter Preferred Provider Organization (PPO) health care contracts.
- Validate why Point of Service (POS) plans use financial incentives.
- Discuss one of the premises of unit based managed care.
- Recognize what critical pathways are used for in unit based managed care.
- Discuss utilization management with regard to the quality of delivered health care services.
- Recall why utilization management concepts were introduced.
- Define severity of illness (SI).
- List the tree components to the utilization review process.
- Identify a good question to ask when doing a concurrent or continued stay review.
- Relate how many health care disciplines incorporate some form of case management.
- Recognize other terms for case management.
- Identify how case management organizes patients.
- Recall what advanced skills patient case managers possess.
- Tell how many fundamental steps there are to the process of planning and establishing health care goals.
- Discuss how patient involvement in care relates to the success of case management.
- Differentiate between case management and bedside case management.
- Indicate what the nursing process has fostered in the nurse and how this relates to the transition into case management.
- Relate what the nurse case manager is held accountable for in bedside case management,
- Describe the form of group practice that exists within bedside case management.
- Discuss what the case management plan is used for in bedside case management.
- Explain the importance of communication in the successful delivery of quality patient care.
- Recognize the roles of the nurse case manager in a bedside case management approach to patient care.
- Identify what approach is used to accomplish cost effective, outcome
oriented, quality patient care within the shared group practice framework of bedside case management.
- Determine what the nurse case manager supervising a team must be aware of in order to Judiciously delegate patient care tasks.
- Summarize points to cover in the change of shift report.
- Discuss what happens during intra shift report.
- Discuss the use of patient care protocols.
- Relate how bedside case management affects cooperation between the hospital based
patient care disciplines and the community health care agencies.
- Describe the contents of the case management plan.
- Summarize the affect of bedside case management on treatment, fragmentation of health care services, and health care service delays.
- Report what the influence of bedside case management is on patient education.
- Discuss what encouraging the patient's participation in care activities does for the patient.
- Recognize what bedside case management does for the nurse case manager.
- Indicate what bedside case management does for the skill level of the patient care team members.
- Discuss how bedside case management elicits physician satisfaction.
- Select the focus of practice for the bedside case manager.
- Summarize the qualifications the bedside case manager must inherently possess in order to orchestrate quality patient care that meets managed care dictates and requirements.
- Identify clinical responsibilities of the bedside case manager.
- Determine reasons the bedside case manager acts as a patient advocate.
- Discuss the financial responsibilities of the bedside case manager.
- Specify the learning needs of the new bedside case manager.
- Identify when the use of critical pathways was developed originally.
- Recognize the overall goals of a critical pathway.
- Report the categories for which the clinical pictures of patients for whom critical pathways are developed fall into.
- Identify variables that must be considered when developing a critical pathway.
- Choose the categories that the processes and interventions of a critical pathway can be grouped under.
- Relate how critical pathways affect patient care practices.
- Identify how soon after admission the critical pathway chosen for the patient has to be addressed with the patient's physician(s).
- Indicate what type of data critical pathways allow for the use of when determining goal evaluation.
- List the components that protocols contain.
- Recall the events that variances show can influence patient outcomes.
- Describe what bedside case management does to the focus of quality improvement.
- Discuss ways bedside case management improves the quality of patient care and the delivery of health care services.
- Recall the types of patient care systems bedside case management provides for.
- Indicate how bedside case management is similar to continuous quality improvement (CQI).
- Define patient care standard outcome indicators.
- Report at least four reasons bedside case management is instituted in acute care facilities.
- Recognize the first step in the planning process before bedside case management can actually be instituted.
- Determine the overall goal of the bedside case management institution task force.
- Summarize ways to encourage physician participation in the institution of a bedside case management model of patient care delivery.
- Recall responsibilities that the bedside case manager will be held accountable for.
- Relate what must be assessed before instituting a bedside case management patient care delivery model.
- Indicate what the nurses who take on the bedside case manager role will need to know how to do.
- Identify during which phase the process for evaluating bedside case management must be developed.
- Discuss what connection nursing case management will have the ability to promote.
- Relate what case management practice will be molded by in the twenty first century.
- Recognize what it will be necessary for case management programs to do as the population of the United States grows older.
- Identify two relatively new case management programs that nurses will probably become even more involved with.
"I loved this course...very informative!" -Anne
Stallbohm, LVN, CA.
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