The ABCs of case management. A review of the basics

As managed care continues to emerge as a dominant structure for delivering and reimbursing health care, nursing is responding and assisting in reshaping the health care system. Nursing case management as a new delivery of care includes providing and coordinating care across the continuum. The continuum includes prevention, wellness, acute, rehabilitation, long term, and hospice care. Various definitions of case management exist and are dependent on the discipline that employs them, the setting in which they are implemented, and the personnel and staff mix used in their implementation. Patient identification, assessment, planning, implementing and coordinating and evaluating the delivery of service and patient outcomes are components common to all case management models. The nurse case manager should be minimally educationally prepared at the baccalaureate level. She/he should also have expert clinical skills, knowledge of the health care system, health care finances, and legal issues and be an effective communicator. Within the case management model the case manager will use various tools to achieve clinical, quality, and economic outcomes. Some of these tools include practice guidelines, critical paths, variance analysis, protocols/algorithms, risk assessment, and outcome measurement tools.