The Crucial Role of Case Management in Continuous Care and Organizational Impact - Essay Example

Introduction

Healthcare institutions are organizations tasked with an immense social responsibility of taking care of the health and lives of patients. These institutions must ensure teamwork and collaboration between all stakeholders to avail of patient-centered care of the highest quality and safety standards. As a nurse, case management is essential to assessing and planning the best services and programs for the healthcare institution, facilitating and coordinating the delivery of services. Also, case management helps in advocating for the best practice that positively correlates with the bottom line of the organization. This article will investigate the role of case management in aspects of healthcare, develop a case management plan that incorporates the role of insurance and community resources, and coordinate care delivery and case management across a wide spectrum. Case management in healthcare is paramount to the delivery of quality and safe services as well as in changing current practice.

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Explain how the concept ‘continuum of care’ applies in case of management and within your organization

The concept ‘continuum of care’ means that the healthcare system is attentive, adaptable, and adjustable to changes, to provide continuous, quality, and safe care to the population it serves. According to De Regge et al. (2017), as people living in a certain area grow older, the healthcare system must stay sensitive to this change to deliver more-complex healthcare responses to the aging population. Technology conjoined with increasing medical expertise provides more possibilities in the diagnosis and treatment of chronic illnesses that come with old age. However, an inadequate or lacking interface to join hospitals to primary care providers and community-based services could derail the concept ‘continuum of care’. In the case of an aging population, the concept of ‘continuum of care’ means switching from acute medical responses to chronic medical responses, to cater to the needs of older people. Failing to coordinate such change means the failure of the concept of continuous care.

Case management in healthcare is the interface that joins professionals from an array of fields in the quest to provide integrated and continuous care that meets the needs of the patients. The delivery of safe and quality care depends on the collaboration between hospitals, specialized care institutions, integrated health services, general practitioners, care providers, and community-based services. As hospitals continue to offer more complex services, the aforementioned practitioners must work in harmony lest risk redundancy and incoherence. Furthermore, healthcare practitioners must tackle ever-changing challenges in the workplace, including increasing pressure from ethical and legal issues like the right to informed consent and patient confidentiality, calling for better alternatives to resolve such debates (Summers, 2015).

Explain new services or programs that your organization is currently evaluating or performing that are assisting patients to reach their health goals

The Welfare of Nurses

Public and private actors might pressure hospital institutions to deliver the best care without considering changes in the nurses’ workforce, compensating and paying healthcare workers, and the effect of health policies on the nurses’ performance. A transition in health policies should also encourage a paradigm shift in the labor welfare of nurses to expand the current nursing roles, create new roles and provide more opportunities for nurses. Buerhaus et al., 2012 insist on preparing and training nursing leaders who can shape the vision and future of their counterparts. Cultivating a new crop of nurse leaders is essential to preparing nurses for the impending health reforms.

Transitional Care

Patients often experience poor quality care as they transition from the hospital to home, demanding a patient follow-up program that caters to all their needs (Davis et al., 2012). Hospitals must train their healthcare providers on the initiatives to deconstruct barriers to effective patient follow-up. Proper training helps the practitioners gain insight on improving the quality of transitional care, through improved communication between patients and the hospital institution. Some transitional care involves remote patient monitoring using data-transmitting devices, which brings concern about the safety of the patients’ data. Healthcare providers must provide hospitals with the necessary tools to overcome hindrances to improved transition care.

Equipping Ambulances

Healthcare institutions must continually improve their service delivery to meet the diverse and ever-changing needs of the patients. Ambulatory care is one section of healthcare that deserves attention because sometimes, the ambulance is the first response to some medical emergencies like accidents or home care (De Regge et al., 2012). Ambulances carry additional medical appliances suited for use in emergency responses; therefore, any addition to these emergency instruments must consult the paramedics and physicians who use them. Healthcare service providers should fit ambulances with the appropriate, modernized, and improved appliances to offer the best care to patients before arrival or admission to the hospital.

Explain how these new services/programs can affect the bottom line of the organization

The three services/programs mentioned in the last section are the welfare of nurses, transitional care, and equipping ambulances. These programs carry varying effects on the bottom line of the hospital institution as an organization. Improving the welfare of nurses through better pay, better training, and increased hiring would improve health outcomes for the hospital while also increasing the cost of healthcare. Checking the welfare of nurses is important to ensure they fit their job descriptions, attain job satisfaction, and have enough opportunities for career development (Elwood, 2016). Improving nurses’ welfare improves the safety and quality of healthcare but also increases the costs.

Transitional care is an important factor in the delivery of quality healthcare, especially for an aging population. Better transitional care translates to fewer readmissions, sufficient care for those with complex healthcare needs, and a feeling of satisfaction among healthcare providers for doing their best. Good transitional care reflects the adequacy of an institution to provide quality care and increases the satisfaction of patients. However, transitional care that involves the monitoring and transmitting of patient data causes ambivalence. While others do not mind the acquisition, monitoring, and transmission of personal data, others do not prefer devices that monitor their location, blood pressure, or blood sugar levels at all times.

Technology and modernized equipment are indispensable in a healthcare setting because of their accuracy and reliability in delivering positive healthcare outcomes. Such technologies fitted in ambulances are critical in offering the first response to several emergencies. Nonetheless, the use of technology and equipment, for instance, in ambulances, must not only serve the patients but also fit the use of paramedics. The input of paramedics and physicians on the best tools for use during emergencies is paramount.

Choose a quality indicator and discuss how it can influence the quality of care

Some hospitals reported the use of quality indicators as internal tools for improving the quality of care because measuring the quality of care reveals areas requiring performance improvement (Asgar et al., 2014). Quality indicators are also important to external stakeholders like the government, insurers, or patients in providing a summary of the level of accountability within the hospital. Quality indicators include organizational indicators, outcome indicators, and clinical process indicators. These indicators measure organizational, clinical, or outcome functions within the hospital to gauge patient safety, clinical effectiveness, and patient-oriented issues.

Organizational indicators include hospital bed occupancy, hospital bed turnover, length of hospital stay, waiting times for admission and discharge, waiting time for emergency rooms, and the presence of clinical guidelines. All three indicators of quality healthcare (organizational, clinical, and outcome indicators) work interchangeably to assess the structures, processes, and outcomes in healthcare settings. Organizational indicators of quality healthcare are vital to quality improvement initiatives because information on factors like bed occupancy rates helps the hospital to make decisions on equipping the institution with more beds.

Assess the practice of linking hospital reimbursement to performance outcomes

Internal and external stakeholders of a hospital institution could use a quality indicator to measure and compare the performance of several hospitals, and then punish or reward the poor and good performers. The outcome of this process is the increment or reduction in reimbursement offered by internal or external stakeholders depending on performance outcomes. Linking hospital reimbursement to performance outcomes occurred when the Centre for Medicare and Medicaid Services (CMS) imposed a penalty on hospitals with a high, unplanned readmission index of patients with acute chronic obstructive pulmonary disease (COPD) (Shah et al., 2016).

The affected hospitals received lesser reimbursement for the treatment of Medicare patients for their ‘poor performance’ in acute COPD. If the hospitals with high readmission rates for patients with acute COPD receive lesser reimbursement, this increases the disparity in healthcare for disadvantaged groups. Ethnic minorities and low-income individuals have higher readmission rates compared to the rest of the population; therefore, cutting Medicare reimbursement hurts hospitals in low-income neighborhoods more. Although linking hospital reimbursement to performance outcomes keeps hospitals ‘on their toes’ in terms of performance, it could have unintended outcomes for disadvantaged groups (Feemster & Au, 2014).

Conclusion

Conclusively, the dream of universal healthcare of the best quality and safety will remain an illusion without proper case management within hospitals as organizations. Case management reveals the shortfalls, areas requiring improvement, and recommendations to better the healthcare system. Delivering the concept ‘continuum of health’ requires the collaboration of all stakeholders in the massive case management project. Checking the welfare of nurses, the transition of patients from hospital to home care, and assessing quality indicators are essential to safe and quality healthcare.

References

Asgar, A. H., Ravaghi, H., Kringos, D. S., Ogbu, U. C., Fischer, C., Azami, S. R., & Klazinga, N. S. (2014). Using quality measures for quality improvement: the perspective of hospital staff. PloS one, 9(1), e86014.

Buerhaus, P. I., DesRoches, C., Applebaum, S., Hess, R., Norman, L. D., & Donelan, K. (2012). Are nurses ready for health care reform? A decade of survey research. Nursing Economics, 30(6), 318.

Davis, M. M., Devoe, M., Kansagara, D., Nicolaidis, C., & Englander, H. (2012). “Did I do as best as the system would let me?” Healthcare professional views on hospital to home care transitions. Journal of general internal medicine, 27(12), 1649-1656.

De Regge, M., De Pourcq, K., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC health services research, 17(1), 550.