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| Introduction to Case Management | |
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| Using This Guide | |
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| Healthcare Industry in Crisis | |
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| History of Case Management | |
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| Changes in Reimbursement: The Driving Force Behind Case Management | |
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| Continuous Quality Improvement and Case Management | |
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| Nursing Case Management | |
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| Early Community-Based Case Management | |
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| History of Critical Pathways | |
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| Case Management Plans Today | |
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| Multidisciplinary Care Planning | |
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| Choosing a Case Management Tool | |
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| Physician Support | |
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| Benefits of Case Management | |
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| Interdisciplinary Team | |
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| Change Process | |
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| Managed Care | |
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| Financial Reimbursement Systems | |
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| Origins of the Prospective Payment System: An Overview | |
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| Use of Documentation | |
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| Impact of DRGs on the Healthcare Industry | |
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| Use of DRGs Today | |
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| APCs: Medicare's Outpatient Prospective Payment System | |
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| Home Care Prospective Payment System | |
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| Inpatient Rehabilitation Facility Prospective Payment System | |
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| Long-Term Care Reimbursement (Skilled Nursing Facility) | |
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| Government Programs | |
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| Third-Party Payers/Managed Care Organizations | |
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| Managed Care and Its Stages of Development/Maturation | |
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| Integrated Delivery Systems as a Response to Managed Care | |
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| Other Health Benefit Plans | |
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| Proactive Tactics to Counteract the Effects of Managed Care | |
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| Case Management Models | |
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| Types of Case Management | |
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| Hospital-Based/Acute Care Models | |
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| Community-Based Case Management Models | |
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| System Models | |
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| Chronic Care Case Management | |
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| Long-Term Care Case Management | |
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| Managed Care Models and Case Management | |
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| Designing Case Management Models | |
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| Setting up the Case Management Program | |
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| Role of the Case Manager | |
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| Case Management Process | |
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| Various Roles Played by Case Managers | |
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| Roles of the Case Manager in Varied Settings | |
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| The Social Worker as Case Manager | |
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| The Advanced Practice Nurse as Case Manager | |
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| Utilization Management | |
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| Relationship Between Utilization Management and Case Management | |
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| The Review and Certification Process | |
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| Criteria Used for Utilization Review | |
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| Criteria Used for Utilization Review--InterQual | |
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| The Continuum of Care | |
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| Applying ISD Criteria | |
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| Milliman & Robertson | |
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| Denials and Appeals | |
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| Peer Review Organizations | |
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| What Case Managers Need to Know About Managed Care Contracts | |
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| Working with Patient Accounts | |
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| Reporting Utilization Management Data | |
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| Transitional Planning and Case Management | |
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| Transitional Planning or Discharge Planning | |
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| The Continuum of Care | |
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| The Case Manager's Role in Transitional Planning | |
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| Transferring Patients to Other Facilities | |
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| Disease Management | |
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| Evolution of Current Disease Management Programs | |
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| Disease Management and Case Management | |
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| Impact of Disease Management on Quality and Cost | |
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| Designing Disease Management Programs | |
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| Putting It All Together: The Disease Management Template | |
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| St. Elizabeth of Hungary Clinic's Disease Management Program | |
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| Skills for Successful Case Management | |
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| Nursing Process | |
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| Leadership Skills and Functions | |
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| Communication and Other Interpersonal Skills | |
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| Communication Paths | |
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| Successful Leaders | |
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| Case Manager's Documentation | |
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| Importance of Documentation | |
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| Role of Case Managers in Documentation | |
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| Charting by Exception | |
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| Documenting Patient Education | |
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| Case Presentation | |
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| Hiring Case Managers: Role of the Candidate and the Interviewer | |
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| Candidate | |
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| Characteristics Looked for in Potential Candidates for the Case Manager's Role | |
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| Interviewer's Role | |
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| Follow-up Interviews | |
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| Curricula and Certification in Case Management | |
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| Background of Case Management Educational Programs | |
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| Case Management Certificate Programs | |
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| Case Management Noncertificate Programs | |
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| Case Management Degree Programs | |
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| Certification in Case Management | |
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| The Commission for Case Manager Certification | |
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| The American Nurses Credentialing Center's Case Management Certification | |
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| Forecasting the Future of Case Management Credentialing | |
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| Developing Case Management Plans | |
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| Overview of Case Management Plans | |
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| Types of Case Management Plans | |
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| Process of Developing Case Management Plans | |
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| Patient and Family Case Management Plans | |
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| Strategies for Physician Participation and Buy-In | |
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| Organizing the Work of the Interdisciplinary Team | |
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| Quality Patient Care | |
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| Importance of Quality | |
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| Meaning of Quality | |
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| Characteristics of Quality | |
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| Setting the Standards for Quality | |
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| A Historical Review of Quality | |
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| Using Structure/Process/Outcomes to Measure Quality | |
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| Quality Categories of Organizational Values | |
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| Case Management and CQI | |
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| Consumer/Patient Satisfaction | |
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| Cost/Quality/Case Management | |
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| Case Management and Outcomes Management | |
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| Measuring the Effectiveness of Case Management | |
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| Outcomes as Indices of Quality | |
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| Outcomes Not Directly Related to the Patient's Health | |
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| Outcomes Related to Patient Health | |
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| Clinical Outcomes | |
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| Patient Care Variances | |
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| Outcomes Management and Outcomes Classification | |
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| Organization-Specific Outcome Measures--Evaluating the Department of Case Management | |
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| Organization-Specific Outcome Measures--Evaluating the Case Manager | |
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| National Quality Indicators | |
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| Report Cards | |
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| Linking JCAHO to Case Management | |
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| Overview of the JCAHO Standards | |
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| Continuous Self-Evaluation and Improvement | |
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| Relationship of Case Management to JCAHO Standards | |
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| Case Management and Root Cause Analysis | |
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| Documentation Standards | |
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| Interdisciplinary Approach to Patient Care | |
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| Legal Issues in Case Management | |
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| Case Management Systems, the Case Manager, and the Legal Process | |
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| Standards of Care | |
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| Negligence | |
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| Malpractice | |
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| Informed Consent | |
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| Legal and Ethical Dilemmas for the Case Manager | |
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| Noncompliance/Mismanagement | |
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| Documentation | |
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| Case Management Plans | |
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| Patient Confidentiality | |
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| Application of Legal Concepts to Case Management Practice | |
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| Sources of Anxiety for Today's Case Managers | |
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| Basis for Assigning Liability in Case Management | |
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| The Difference Between Negligence and Malpractice | |
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| Establishing the Standard of Care for the Case Manager | |
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| Case Management "Hot Spots" That Have Already Received Legal Review | |
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| Role of the Medical Record Review in a Lawsuit | |
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| Professional Misconduct | |
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| Protecting the Case Manager in This Litigious Society | |
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| Ethical Issues in Case Management | |
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| Managed Care and Patient Advocacy | |
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| Case Management and New Ethical Challenges | |
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| Maintaining Ethical Integrity | |
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| The Deliberative Framework | |
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| Organizational Ethics | |
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| Using the Internet for Case Management | |
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| The Internet | |
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| Patient and Family Education Resources | |
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| Other Uses of the Internet by Case Managers | |
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| Assessing the Quality of Health Information on the Internet | |
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| Case Management-Related Web Sites | |
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| Appendixes | |
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| Community Nurse Case Management Problem List and Plan of Care | |
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| Community Nurse Case Management Intervention Flow Sheet and Problem Rating Scale for Outcomes | |
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| Community-Based Wound Care Pathway and Flow Sheet | |
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| Home Care Plan for Congestive Heart Failure and Hypertension | |
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| Subacute Care | |
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| Clinical Guideline for Short-Term Subacute Admissions | |
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| Referral Assessment Form | |
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| Subacute Data Collection Tool | |
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| Long-Term Care Resident Assessment Instrument Case Study and Care Plans | |
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| Preprinted Order Sets | |
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| Documentation Guides for Physicians | |
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| Case Manager--Inpatient | |
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| Case Manager--Admitting Office | |
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| Case Manager--Emergency Department | |
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| Case Manager--Community | |
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| Physician Advisor | |
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| Guide for a Case Manager's Competency-Based Performance Appraisal | |
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| Performance Management Form--Case Coordinator | |
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| Glossary | |
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| Index | |