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Disease Management
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Written by Robin S. Boltz, RN, MPH
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.jpg) Exploring Hepatitis B and C and HIV
The research-based facts for bloodborne diseases are constantly changing, requiring case managers of all populations to update their knowledge in order to accurately assess and convey the risks of transmission of these diseases to their patients.
The term bloodborne pathogen is a regulatory term used by the Occupational Safety and Health Administration (OSHA) to define vulnerabilities of workers, but it is not a true description for the mode of transmission for the majority of these pathogens. Of the diseases most commonly referred to as bloodborne diseases, HIV, hepatitis B, and hepatitis C, only hepatitis C is likely to be limited to bloodborne transmission. Of the other diseases, blood-like fluids such as semen, spinal fluid, amniotic fluid, and breast milk frequently carry the virus, and nonblood-like fluids such as mucous, saliva, digestive fluids, vaginal lubrication fluids, urine, and feces, are possible sources.
Only HIV and hepatitis C are absent in a transmittable concentration from the nonblood-like group of human materials. While direct injection is the most certain mode of transmission for all the viruses, infection has occurred through a fresh break in epidermal skin or other susceptible tissue such as mucous membranes and eyes because they are absorbent, easily penetrated, and highly vascular.
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Written by Helen M. Sorenson, MA, RRT, FAARC
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Friday, 02 October 2009 21:08 |
 Sleep Apnea: Defining the Need for Respiratory Care Case Managers
Over the years changes in the health care environment have dictated changes to what we have come to understand as case management. Presently, the role of the case manager in most areas of the country is performed by nurses. This is due in part to general shifts in health care. The advent of the diagnostic related groups in the 1980s shifted the focus of case management from making more resources available to making social services more economically feasible, and in some cases limiting access for patients. Nurses, viewed as trusted professionals, established a medical necessity for many services.
The economic situations facing hospitals over the past few decades also have been a driving force in the utilization of case managers as an alternative to the delivery of direct care services, as Peggy Rossi highlights in her book Case Management in Health Care.
What this means is that case management has become, in a sense, defined by limitation. Case management, however, is not and should not be discipline-specific. Not in a strict sense. The variation in expertise among and between disciplines lends itself to the potential for enhanced satisfaction among patients assigned to case managers. Dealing with someone knowledgeable in specific areas of patient care management will provide a higher level of comfort to the patient and may ultimately lead to better compliance with therapeutic interventions. |
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Written by Teresa M. Treiger, RN-C, MA, CCM, CCP
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Friday, 02 October 2009 20:59 |
 Case Management at the Ready
As the shadow of major health care reform looms on the horizon, continuity of care and transition of care have quickly become mantras on Capitol Hill. Exactly what shape reform will take remains undefined. However, the case management community is uniquely positioned to assert influence on and facilitate adoption of these changes.
It is generally recognized that continuity of care has three major aspects — information, management and the patient-provider relationship. Continuity of information requires consistent and timely communication of clinical information from one locus of care to the next. Continuity of management calls for a well-coordinated effort to ensure the patient’s needs are identified, barriers to care are resolved, and gaps in care are addressed. Case managers are pivotal here, ensuring these critical events occur. Finally, the patient-provider relationship must be a consistent, ongoing collaboration focused on the patient’s individual health care needs. As a member of the patient’s care team, case managers often act as facilitator and coach to help strengthen a patient’s relationship with his physician(s).
At the foundation of care continuity is a strong primary care system. According to the Institute of Medicine’s (IOM) highly influential Crossing the Quality Chasm report, released in 2001, the health care system of the 21st century centered around the following descriptive elements: safe, effective, patient-centered, timely, efficient and equitable. As we move forward in defining what shape the new health care system will take, there are four important aspects (in no way an all-inclusive list) of what will hopefully be a positive end result. Success will come slowly, if at all, in the absence of stable health information technology (HIT). This article previews how pay for performance, electronic health records, coding and reimbursement, and patient flow may continue to evolve as HIT receives more focused attention. |
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