Professional Case Management最新文献

Purpose: Advanced care planning supports discussions about patients' preferences for end-of-life care, frequently resulting in the completion of health care proxy documentation (HCP). This quality improvement project aimed to increase HCP documentation rates for hospitalized patients with cognitive impairment, including those diagnosed with dementia and delirium.

Primary practice setting: This project was implemented at a 216-bed acute care, community-based teaching hospital in the northeastern United States.

Methodology and sample: The intervention targeted case managers and nursing staff in medical-surgical and stepdown units. Case managers completed an asynchronous educational module on revised workflows for identifying and documenting health care proxy among cognitively impaired patients, followed by a post-training assessment. Concurrently, nursing staff received a practice alert reinforcing their role in verifying patient-designated health care agent upon admission. Program evaluation included demographic data, staff feedback, and aggregate chart reviews to measure changes in documentation rates and process adherence.

Results: HCP documentation for hospitalized patients with cognitive impairment increased from an average of 62% to an average of 75.44% over the 12-week implementation period.

Implications for case management practice: A structured, case manager-led workflow significantly improved the documentation of health care proxies for patients with cognitive impairment. Future initiatives should integrate nurse-led education on HCP verification and promote interdisciplinary collaboration to enhance advance care planning practices across care teams.

Purpose/objectives: The purpose of this project was to evaluate the impact of a nurse discharge navigator implementing an education and structured outpatient follow-up program on reducing 30-day readmissions for adult patients with sepsis.

Primary practice setting: This project was implemented at an 847-bed academic hospital in the southeastern United States.

Findings/conclusions: Patient capture in the study was poor, driven by high rates of cancer diagnoses, comfort-directed care, and frequent discharges to postacute care. Readmission rates for patients receiving the full intervention ( n = 16) were 25% ( n = 4). Overall readmission rates for patients with sepsis in 2024 were 13.3% ( n = 61). The outcomes of this project were influenced by the advanced comorbidities of the participants.

Implications for case management practice: Case management of patients with sepsis should be comprehensive. Caregivers should be involved early to initiate education on the disease process, have clear communication with the follow-up team, and involve close, structured follow-up that can be adapted to the postacute care setting. One promising area for improvement of this intervention would be the inclusion of a Hospital at Home program as a transition program to the transition clinic.

Purpose of study: The Practice Environment Scale of the Nursing Work Index (PES-NWI) is widely used to measure the practice environment across nursing populations. Case management is a specialty focused on care coordination to meet the clinical and financial goals of medically and socially complex individuals across the care continuum. Despite its importance, limited research exists on the hospital case management practice environment, and no instrument currently measures this concept. This study aimed to adapt and validate the psychometric properties of a hospital case management version of the PES-NWI.

Primary practice setting: Acute care hospitals where case managers practice.

Methodology and sample: Following expert panel feedback, the PES-NWI was adapted and shortened from 31 to 23 items for use in hospital case management. A convenience sample of 160 hospital case managers across the United States was recruited via social media and professional networks. The psychometric evaluation included assessments of validity (content validity via expert panel review, known-groups construct validity, and factor analysis) and reliability (Cronbach's alpha and item-total correlations).

Results: Participants included case managers working in 34 states. Most were female (92%) from the nursing discipline (79%) and social work (21%). Nearly 60% held case management certification, and 40% had over 10 years of experience in the field of case management. Factor analysis revealed a four-factor structure with items cleanly loading between 0.44 and 0.74. The four factors represented Supportive and Participatory Leadership, Staffing and Resource Adequacy, Opportunities for Professional Development, and Fostering Teamwork and Collaboration. The factor structure of the adapted instrument differs from that of the original PES-NWI, indicating a need for further testing. Nevertheless, the adapted instrument demonstrates strong internal consistency (overall Cronbach's alpha of 0.93) and item-to-total correlations from 0.37 to 0.80.

Implications for case management practice: The adapted instrument, Practice Environment Scale for Hospital Case Management, the first to measure the hospital case management practice environment, demonstrates adequate reliability and validity. It provides a critical foundation for future research and supports the development of evidence-based strategies to enhance hospital case management practice. Understanding this environment is crucial for advancing workforce development, enhancing professional satisfaction, and maximizing the impact of case management in acute care settings.

Purpose of study: Case managers in the health and human service profession are known to be at an elevated risk for burnout. Most of the research in this area focuses on contributing factors of burnout as compared to reductive measures. Where it does exist, the emphasis is directed toward agency versus individual interventions. Self-care is often proclaimed to be effective in lowering burnout at the individual level, but the evidence is insufficient. The aim of this study was to narrow the gap by exploring self-care strategies along with workplace support as potential protectors against burnout among case managers.

Primary practice settings: Participants in the study were primarily employed in hospitals and insurance companies. To a smaller extent, some case managers were working in community and mental health settings.

Methodology and sample: This study used a cross-sectional, quantitative, and survey design. Through the Case Management Society of America, 257 case managers responded to a Qualtrics survey that was used to explore two research questions and three hypotheses. Through the data cleaning process, the final sample was 203 case managers.

Results: High to moderate levels of burnout were found in the study with occasional engagement in self-care strategies among participants. They also reported moderate work support with more coming from their coworkers than their supervisors. Partial support was found for the three hypotheses where increasing levels of self-care strategies significantly predicted lower emotional exhaustion and depersonalization but also lower instead of higher levels of personal accomplishment. Increasing levels of workplace support, specific only to coworkers, predicted lower emotional exhaustion.

Implications for case management practice: The findings from this study reveal the need to further explore the way self-care strategies influence burnout. As a baseline, this study showed that self-care can lower some forms of burnout. Therefore, case managers should seek to develop and implement a consistent self-care plan. More research is needed to identify the specific mechanisms of self-care that are at play. Some questions to explore include whether certain forms of self-care are more helpful than others, if the fit between the individual and selected self-care strategy is important, and the factors that contribute to successful self-care implementation. Answers to these questions will provide better guidance to case managers on how to practice self-care. This study also highlights the significance of workplace support from coworkers in relation to emotional exhaustion. As such, health and human service organizations should consider ways to foster a culture that supports positive coworker relationships, as in the case of mentoring programs or team-building activities.

Purpose/objectives: This study qualitatively explores the long-term care needs of elderly residents on Sakushima, a remote Japanese island, to identify essential factors for maintaining independent and meaningful lives.

Primary practice settings: This study was conducted in a Japanese remote island, focusing on primary care and community-based long-term care settings. In addition, it is important to note that health care and long-term care resources are gradually becoming depleted as the population declines.

Findings/conclusions: Three interconnected themes of needs were identified: (1) Medical Care and Rehabilitation, (2) Challenges of the Natural Environment and Living Infrastructure, and (3) The Centrality of Ikigai and Social Relationships. The findings suggest that a socially constructed care model that formally leverages the island's unique social and occupational structures is essential for supporting the well-being of elderly residents.

Implications for case management: A holistic care model integrating medical, environmental, and social support is crucial for remote island populations. Case managers should consider residents' sense of purpose (ikigai) and social ties as vital components of care planning. The authors propose establishing a "Sakushima Rehabilitation Coordinator" to provide preventative, lifestyle-integrated interventions. Utilizing "Special Services for Remote Islands" can formally support and sustain existing informal care networks. To achieve proper operation of the LTCI system based on regional characteristics, flexible trials and adjustments that take cultural factors and the natural environment into account should be actively promoted.

Purpose: The purpose of this article is to enhance a person-centered approach in case management, disability management, and allied disciplines by taking into account the environmental factors affecting people's physical, mental, and emotional health. Drawing from recent research, as well as the example of health support for agriculture producers and workers, the article underscores the weather-related risks that impact people because of where and how they live and work.

Primary practice settings: The article addresses professional case managers and allied professionals such as disability management specialists in a variety of settings, including acute care, subacute/rehabilitation, workers' compensation, occupational health and safety, primary care, and community-based care.

Implications for case management: In response to evidence of the rising health risks from weather-related events, professional case managers should expand how they assess individuals (known as "patients" in some settings) to identify their existing and potential risk factors, including where people live and work and the weather-related risks that may be present in those environments. A case management assessment of an individual's weather-related health risks could not only inform a particular treatment episode but also help avoid preventable setbacks and recurrence of illnesses. If those risks are not addressed, they could lead to costly emergency department visits and/or hospitalization.