Learning Objectives:

After reading the chapters in this book, the learner will be able to:

1. Determine if case management is a new model for the delivery of patient care.
2. Discuss the evolvement of case management.
3. Explain why the coordination of public services was set up.
4. Recognize what the community service focus centered on.
5. Discuss why the United States Public health Service designed an early case management system.
6. Identify the act that made funds available in the mid 1930s for the provision of meeting individual client health care needs.
7. Name the movement that had a major impact on the refinement of case management.
8. Recognize when the term 'case management" first emerged in social welfare literature and practice.
9. Relate why Diagnosis Related Groups (DRGs) were set up.
10. Explain what form of nursing case management emerged in the mid 1980s to deal with restraints imposed by DRGs and third party payer resource conservation requirements.
11. Discern whether managed care is a new concept.
12. Discuss what DRGs were designed to do.
13. Explain what the initial focus of the insurance industry was in the mid 1980s.
14. Define capitation.
15. Identify what the focus of health care is now.
16. Discuss how health care institutions survive.
17. Relate how the cost for technology is paid for.
18. Compare lengths of stay with patient acuities.
19. Determine how duplication and fragmentation of health care services are influenced by the changing health care delivery system of the 1990s.
20. Recognize what the viability of health care institutions relies on.
21. Report what health care administrators have to do with finite resources in a limited reimbursement climate.
22. Define the goal of third party payer managed care.
23. Discuss what a primary care physician in a Health Maintenance Organization (HMO) is frequently charged with.
24. List the five HMO models.
25. Summarize the Individual Practice Associations' (IPAs) policy on reimbursement for health care services performed by non-member providers.
26. Report why physicians and health care facilitators enter Preferred Provider Organization (PPO) health care contracts.
27. Validate why Point of Service (POS) plans use financial incentives.
28. Discuss one of the premises of unit based managed care.
29. Recognize what critical pathways are used for in unit based managed care.
30. Discuss utilization management with regard to the quality of delivered health care services.
31. Recall why utilization management concepts were introduced.
32. Define severity of illness (SI).
33. List the tree components to the utilization review process.
34. Identify a good question to ask when doing a concurrent or continued stay review.
35. Relate how many health care disciplines incorporate some form of case management.
36. Recognize other terms for case management.
37. Identify how case management organizes patients.
38. Recall what advanced skills patient case managers possess.
39. Tell how many fundamental steps there are to the process of planning and establishing health care goals.
40. Discuss how patient involvement in care relates to the success of case management.
41. Differentiate between case management and bedside case management.
42. Indicate what the nursing process has fostered in the nurse and how this relates to the transition into case management.
43. Relate what the nurse case manager is held accountable for in bedside case management,
44. Describe the form of group practice that exists within bedside case management.
45. Discuss what the case management plan is used for in bedside case management.
46. Explain the importance of communication in the successful delivery of quality patient care.
47. Recognize the roles of the nurse case manager in a bedside case management approach to patient care.
48. Identify what approach is used to accomplish cost effective, outcome oriented, quality patient care within the shared group practice framework of bedside case management.
49. Determine what the nurse case manager supervising a team must be aware of in order to Judiciously delegate patient care tasks.
50. Summarize points to cover in the change of shift report.
51. Discuss what happens during intra shift report.
52. Discuss the use of patient care protocols.
53. Relate how bedside case management affects cooperation between the hospital based patient care disciplines and the community health care agencies.
54. Describe the contents of the case management plan.
55. Summarize the affect of bedside case management on treatment, fragmentation of health care services, and health care service delays.
56. Report what the influence of bedside case management is on patient education.
57. Discuss what encouraging the patient's participation in care activities does for the patient.
58. Recognize what bedside case management does for the nurse case manager.
59. Indicate what bedside case management does for the skill level of the patient care team members.
60. Discuss how bedside case management elicits physician satisfaction.
61. Select the focus of practice for the bedside case manager.
62. Summarize the qualifications the bedside case manager must inherently possess in order to orchestrate quality patient care that meets managed care dictates and requirements.
63. Identify clinical responsibilities of the bedside case manager.
64. Determine reasons the bedside case manager acts as a patient advocate.
65. Discuss the financial responsibilities of the bedside case manager.
66. Specify the learning needs of the new bedside case manager.
67. Identify when the use of critical pathways was developed originally.
68. Recognize the overall goals of a critical pathway.
69. Report the categories for which the clinical pictures of patients for whom critical pathways are developed fall into.
70. Identify variables that must be considered when developing a critical pathway.
71. Choose the categories that the processes and interventions of a critical pathway can be grouped under.
72. Relate how critical pathways affect patient care practices.
73. Identify how soon after admission the critical pathway chosen for the patient has to be addressed with the patient's physician(s).
74. Indicate what type of data critical pathways allow for the use of when determining goal evaluation.
75. List the components that protocols contain.
76. Recall the events that variances show can influence patient outcomes.
77. Describe what bedside case management does to the focus of quality improvement.
78. Discuss ways bedside case management improves the quality of patient care and the delivery of health care services.
79. Recall the types of patient care systems bedside case management provides for.
80. Indicate how bedside case management is similar to continuous quality improvement (CQI).
81. Define patient care standard outcome indicators.
82. Report at least four reasons bedside case management is instituted in acute care facilities.
83. Recognize the first step in the planning process before bedside case management can actually be instituted.
84. Determine the overall goal of the bedside case management institution task force.
85. Summarize ways to encourage physician participation in the institution of a bedside case management model of patient care delivery.
86. Recall responsibilities that the bedside case manager will be held accountable for.
87. Relate what must be assessed before instituting a bedside case management patient care delivery model.
88. Indicate what the nurses who take on the bedside case manager role will need to know how to do.
89. Identify during which phase the process for evaluating bedside case management must be developed.
90. Discuss what connection nursing case management will have the ability to promote.
91. Relate what case management practice will be molded by in the twenty first century.
92. Recognize what it will be necessary for case management programs to do as the population of the United States grows older.
93. Identify two relatively new case management programs that nurses will probably become even more involved with.

Comments:

"I loved this course...very informative!" -Anne Stallbohm, LVN, CA.