Care Management has been in existence for years. The thrust of the role is to monitor, evaluate and enhance resource utilization while maintaining quality of care. The pivotal assumption being through enhanced patient flow, and coordinated services with appropriate resource utilization, better patient outcomes are achieved.
During times of fiscal restraint, quality may become a secondary concern. This paper presents a framework to assist Care Managers, and administrators, in achieving desired outcomes that embrace fiscal accountability and quality patient care. Donabedian's model1 and Systems theory2,3 are the foundations for this framework.
Get full access to this article
View all access options for this article.
References
1.
DonabedianA. (1992). The role of outcomes in quality assessment and assurance. QRB, 356–360.
2.
SengePM. (1990). The fifth discipline the art & practice of the learning organization. Toronto: Doubleday.
3.
TongesMC, & MaddenMJ. (1993). “Running the vicious cycle backward” and other systems solutions to nursing problems. Journal of Nursing Administration, 23, 39–44.
4.
DavisC. (1998). Using case mix tools with case costing data for utilization management. In JohnsonL.M.RichardsJ.PinkG.H., & CampbellL. (Eds.). Case mix tools for decision making in healthcare (pp. 53–56). Toronto: CIHI.
5.
NagleLShamianJCattMSteinM, & MapaJ. (1998). Using case mix tools with case costing data for utilization management. In JohnsonL.M.RichardsJ.PinkG.H., & CampbellL. (Eds.). Case mix tools for decision making in healthcare (pp. 1–11). Toronto: CIHI.
6.
DonabedianA. (1980). Exploration in quality assessment and monitoring: The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
7.
IrvineDSidaniS, & HallL McGillis. (1998). Linking outcomes to nurses' role in healthcare. Nursing Economics, 16, 58–67.
8.
LangleyGNolanKNolanTNormanCL, & ProvostLP. (1996). The improvement guide: A practical approach to enhancing organizational performance. San Francisco: Jossey-Bass Publishers.
9.
JCAHO (1989). Characteristics of clinical indicators. QRB, 15, 330–339.
10.
GrossmanRG. (1998). Quality improvement: An overview. Journal of Perinatal Neonatal Nursing, 12, 42–50.
11.
BakerR, & PinkGH. (1995). A balanced scorecard for Canadian hospitals. Healthcare Management Forum, 8, 7–13.
12.
AllredCharleneArfordPatriciaMichelYvonneDringRebeccaCarterVicki, & VeitchJoye Scurry (1995). A cost effective analysis of acute care case management outcomes. Nursing Economics, 13(3), 129–136.
13.
LynnMary & KelleyBetsy (1997). Effects of case management on the nursing context-perceived quality of care, work satisfaction, and control over practice. Image: Journal of Nursing Scholarship, 29 (3) 237–241.
14.
MicheelsTeresaWheelerLynette, & HayesBeverly (1995). Linking quality and cost effectiveness: Case management by an advanced practice nurse. Clinical Nurse Specialist, 9(2) 107–111.
15.
ElaineL Cohen. (1991). Nursing case management does it pay?JONA, 21(4), 20–25.
16.
JenningsBMStaggersN, & BroschLR. (1999). A classification scheme for outcome indicators. Image: Journal of Nursing Scholarship, 31, 381–388.
17.
AikenLHSmithHL, & LakeET. (1994). Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32, 771–787.
