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In this section, crisp, compact articles are directed to the professional pursuits of today's busy case manager. Ranging from advice from clinical leaders to explorations of the prominent trends of the industry to best-of examples of programs and initiatives from around the country, this section will orient you with the most salient ideas and tendencies in the practice today. Begin below, or start by exploring a category to the left.
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Profession
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Tuesday, 26 January 2010 15:05 |
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To better understand the intricacies of the consumer direction movement, Richard Scott sits down with Pamela Doty from the Department of Health and Human Services who authored the study New Strategies to Meet Long-Term Care Needs that appeared in an early January issue of Health Affairs.
Can you describe consumer-directed long-term care service programs?
These are service delivery models designed to empower people with chronic disabilities and their families. They gain considerably more choice and control over the who, what, where, when of their home and community-based long-term services and supports than they would have in a more traditional “provider-driven” system.
What do these programs hope to achieve?
The goal is a more flexible service system that is able to be responsive to what service users and families want. We have observed that different constituencies tend to be drawn to consumer direction for somewhat different reasons. For example, among older people, the main motivation is typically that they want to have home care workers whom they know and trust, individuals who know them and their preferences and that they feel comfortable with.
This often means that older people choose consumer direction because this allows them to hire family, friends, and neighbors as their paid caregivers rather than rely on “strangers” from an agency, especially because the evidence indicates that there is much greater turnover among agency workers. Among younger people with disabilities, a major complaint is that the traditional service system is about custodial care (i.e., providing help with personal care and housekeeping tasks as well as protective supervision) instead of promoting independence and enabling them to lead more fulfilling and “self-determined” lives.
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Best Practice
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Tuesday, 05 January 2010 16:20 |
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Richard Scott
In this inaugural edition of The CM Insider section of Case In Point Weekly—a section that will bring readers face to face with thought leaders across case management settings—we sit down with Marcia Colone, Ph.D., ACM, the director of UCLA Health System’s Care Coordination Department, to talk about her department’s guiding principles and key concepts, including advancing the plan of care and escalation.
Richard Scott: First of all, congratulations on your new role with UCLA Health System. How has your transition been so far?
Marcia Colone: My new role as director of care coordination at UCLA Health System started in May 2008 when I crossed the threshold of the new hospital due to open in June. UCLA Health System is rated by World News and Report as third in the nation. Its reputation is well earned as a world class medical facility. The opening of the long-awaited new building heralded a new beginning for the organization and for me as I began my new role as director.
The Department of Care Coordination was formed in 2005 and experienced many changes in leadership and focus. With nearly 100 staff, comprised of RN case managers, social workers and discharge planners on two hospital campuses, the respective roles were clarified and the vision was renewed upon my arrival.
RS: I understand you have a guiding principle at your organization. Can you talk about this principle and what it means.
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Best Practice
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Written by Linda Ferara, RN
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Tuesday, 15 December 2009 21:07 |
 How an ED Countered Overuse
Three years ago Dr. Salvatore Vertaramo came up with an idea. As with most emergency departments, we had developed our own list of “frequent flyers.” Dr. Vertaramo, an ED physician, noticed there were in fact two lists of frequent flyers. The first were those who were very ill and frequented the ED related to their illness—for instance, those with congestive heart failure or cancer.
The second group frequented the ED for pain control. Realizing that an ED is not the most appropriate place for anyone to obtain pain control, Dr. Vertaramo came up with a plan to give this group a contract to lessen their narcotic use. Starting off by trying to convince fellow doctors and those in administration that this plan could work, he was met initially with a dose of skepticism. Even if the plan were effective, was it ethical? Was it even legal?
Dr. Vertaramo enlisted the help of our clinical information department to run a list of everyone who had visited the ED at least 10 times in the past year. He scoured every name and checked to see why they had come to the ED. He compared what medications had been administered both in the ED and by prescription for discharge. Equipped with this information, he took it to administration, where they decided that he could trial his idea for six months and see how it worked—provided it was greenlighted by our legal department, our patient advocates, and corporate compliance. The team identified the process for a contract, a referral list of pain and addiction centers, and options for chronic pain management. All contracts were individualized to target specific patients and their problems.
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