Professional Case Management最新文献

On January 1, 2025, the Advanced Primary Care Management (APCM) services, were inaugurated by the Centers for Medicare & Medicaid Services (CMS). APCM is being launched to address longstanding challenges in primary care delivery, including fragmented care, inadequate compensation for comprehensive services, and the need to better support practices in managing complex patient populations and social determinants of health (SDOH).

Purpose of study: The aim of this quality improvement (QI) project was to determine whether implementing the Agency for Healthcare Research and Quality (AHRQ) Re-Engineered Discharge (RED) Toolkit would impact 30-day readmissions among adult medical-surgical patients in an urban Arizona hospital over 8 weeks. This quality improvement project aims to address the lack of evidence-based practice (EBP) discharge guidelines at the project site and to improve readmissions by translating research evidence into clinical practice.

Primary practice setting: The project site is a single medical center within a hospital system located in an urban area of Arizona.

Methodology and sample: The medical-surgical nurses utilized the AHRQ RED components in the form of a discharge checklist. Education and staff teaching were conducted at the project site, with stakeholders provided with EBP resource materials, including the AHRQ's RED Toolkit and scientific evidence on how this process can impact hospital 30-day readmissions. This checklist incorporates the 11 RED components of the discharge process. The checklist served as a procedural guide for nurses during discharge.

Results: Patient data were collected to measure the impact of the AHRQ RED Toolkit on 30-day readmissions. Data were collected from the electronic health record and EBP tool, the AHRQ RED checklist. Thirty-day readmissions were measured as counts in a sample of 307 patients, with data collected before intervention (n = 199) and again after intervention (n = 108). The frequencies of 30-day readmissions were described using counts and percentage rates, then compared using Pearson's chi-square test. In the comparison patient group, there were 99 readmissions (50%) out of 199 patients. In the intervention patient group, 24 patients (22%) out of 108 were readmitted. Pearson's chi-square test showed a statistically significant difference in the number of patients readmitted within 30 days of discharge [ X 2(1, N = 307) = 22.0; p = .001).

Implications for case management: The AHRQ RED components are evidence-based discharge interventions and strategies that have been proven to be crucial in reducing readmissions and improving patient outcomes. The project results highlight the importance of incorporating EBP guidelines into health care settings and validate the effectiveness of these interventions in bridging gaps in patient care, such as avoidable readmissions. The project outcomes demonstrate the role of the RED components in guiding case managers during a patient's hospital discharge. Applying the RED components was essential in preventing readmissions, thereby influencing health care and case management practices, including ensuring safe discharges, reducing costs, and improving care quality. The project outcomes showed significant improvements in the discharge process, providing opportunitie

Purpose of study: The purpose is to describe sepsis survivors' functional recovery and symptom experience following Intensive Care Unit (ICU) hospitalization.

Primary practice settings: Academic Medical Center, Community Living.

Methodology and sample: This longitudinal observational study recruited participants during hospitalization at two adult ICUs in a single Midwestern academic medical center. Participants completed surveys to assess function and symptom experience at baseline (discharge), 1-month, 3-months, and 6-months post-discharge.

Results: Participants were non-Hispanic Whites with mean age 55.4 years (SD = 17.0). The majority were discharged to home (78.6%), with 3 (21.4%) discharged to a skilled nursing facility or acute rehabilitation unit. Participants had notable improvements in mobility, self-rated health, and fatigue from discharge to 6-months post-discharge. Increases in mobility from discharge to 1 month, 3 months, and 6 months were statistically significant (α < .05). Decreases in fatigue from discharge to 1 month and 6 months were statistically significant (α < .05). Cognitive and social engagement and other symptom experience measures did not differ significantly during the study period.

Implications for case management practice: Findings reveal trends in mobility recovery and symptom experience post-hospitalization, which are important considerations post-ICU sepsis hospitalization. This study reinforces the need to promote early mobilization of patients during hospitalization and work with patients to develop strategies for mobility recovery post-hospitalization, as part of a comprehensive plan which integrates a client's medical, behavioral, social, psychological, functional, and other needs. The authors encourage assessment of common symptoms, including pain, fatigue, anxiety, and sleep disturbance, experienced by sepsis survivors during and post-hospitalization. As a result, case managers will be better positioned to implement evidence-based interventions to promote recovery and reduce symptom burden and improve outcomes. Evidence-based interventions should include those that are centered on client's functional and symptom-related needs, preferences, safe mobility, and facilitate awareness of and connections with community supports and resources.

Methods: This study used a qualitative descriptive design. Through snowball sampling, community members who have experience with loved ones receiving end-of-life care were recruited by snowball-sampling. The interviews lasted approximately 90 minutes. Two open-ended questions were posed, and participants led the discussion by interpreting the questions in any way they wanted and telling the story they wanted to tell. Interviews were transcribed into Excel, and line-by-line analysis was utilized to group data (answers) into developed themes; themes were then broken down into subthemes. Literature was consulted to understand themes further.

Conclusions: For decades, research has recommended truth and transparency in end-of-life care discussions with patients, families, and family-centered care. This study demonstrated that, in practice, this is often not done, resulting in further traumatization to families at the end of life. Additional research needs to be done to understand this practice gap and recommend strategies to overcome it.

Results: Families experiencing end-of-life care are experiencing extensive acute trauma. The acute stress of this trauma makes information processing and decision-making very difficult. From the discipline of psychology, a person cannot make good decisions when they are experiencing trauma. At end-of-life, person-centered care is family-centered care. A person's individuality is inextricable from who they are to their family. If we do not care for the family, we do not care for our patients.

Purpose and objectives: This paper aims to raise awareness of the case management community about innovative primary care models, like the Making Care Primary (MCP) which has potential to become the foundation for future primary care reform. It provides professional case managers (PCMs), case management leaders, and primary care providers with examples of evidence-based best practices to apply in primary care settings and programs.

Primary practice settings: Primary care practices and organizations, ambulatory clinics, community-based primary care.

Findings/conclusions: The authors share examples of findings from case management research published over the last 10 years as they pertain to the 3 main domains of MCP-care management, care integration, and community connections-to show the impact case management interventions may have on key outcomes in value-based primary care. The systematic, narrative, and scoping reviews summarized in this paper suggest a set of important case management structures, processes and outcomes relevant to care management, care integration, and community connections that help manage the diverse needs of patients. This evidence is also important in identifying essential case management interventions that ensure person-centered and holistic care and improve patient outcomes especially as they pertain to personal health and wellbeing.

Implications for case management practice: The authors of this paper draw attention to the importance of PCMs and their roles in evolving primary care models in the context of teams and effective teamwork. The contributions of PCMs on primary care teams can be extensive and critical to the successful achievement of desirable primary care outcomes for individuals with complex chronic illness and health-related social needs and thus to the overall success of value-based models of primary care. The evidence the authors summarize provide important guidance on best case management practices in primary care that contribute to better health outcomes.