Measuring and Evaluating Outcomes
Fortunately, the pieces are already in place. As professional case managers determine a plan of care based upon a comprehensive assessment of the patient’s needs, they routinely set goals for patients – e.g., reduction in A1C levels for diabetic patients. These goals then become the criteria against which results can later be measured to determine specific outcomes. When coupled with factors such as avoiding emergency department visits and decreasing hospital readmissions, case managers can quantify the value of case management interventions.
Outcomes evaluation is already a recognized “essential activity” of case management, as illustrated in the field research conducted by the CCMC known as the case manager role and function study. As part of this essential activity, case managers collect outcomes data (e.g., clinical, financial, variance, quality/quality of life, patient satisfaction, core measures, HEDIS measures, return to work, and FIM), document the patient’s response to case management interventions, and analyze outcomes data (Tahan, Campagna, 2010).
Through documentation and data analyses, professional case managers are able to show the connection between case management interventions and results achieved, such as improved health status and self-care for a patient with multiple medical co-morbidities, or gains in functional status for a mental health diagnosis.
Consider the example of a patient being treated in a women’s health clinic who had been diagnosed with a uterine fibroid, which could not be removed until she addressed her alcohol addiction and heavy smoking that put her at risk of serious complications from surgery. In addition, the patient suffered from severe anxiety and was noncompliant on her medications. The case manager worked with the patient and her gynecologist to stabilize the patient before surgery, with a case management intervention plan that addressed her health risks before surgery. The patient had to stop smoking for a period of time and reduce her drinking. The case manager met with the patient in-person and provided support telephonically. As a result of the case management interventions, the patient’s health risks were reduced, which enabled her to have surgery successfully, after which she was admitted to a rehabilitation clinic to further address her addictive behaviors.
As this example shows, the outcomes of a successful surgery without complications and an improved health status for the patient were accomplished through an integrated plan of care. Integral to that plan was the case management intervention to educate the patient about her specific health risks, empower her to address her behaviors, and support the medical outcomes. Although the clinic did not have specific criteria that measured the effectiveness of case management, for the board-certified case manager on the multidisciplinary team, the use of hard data quantified the difference that case management interventions made in the health of the patient.
The thinking and processes already exist within the case management process as patients are assessed, a comprehensive plan of care is devised, care is coordinated, and interventions are delivered. By documenting the status of the patient before and then after the intervention, case managers can observe the results and demonstrate the positive impact of case management. In other words, from the beginning of working with the patient until the end, what changed? It can be that simple. Tests, diagnostics, and medical outcomes document incremental changes in the patient’s medical improvement and/or functional status.
Care delivery takes a team approach; case managers don’t do it alone. The board-certified case manager, however, has the knowledge and expertise to mobilize the necessary resources, including physicians, clinicians, pharmacists, nutritionists, as well as specific therapies and treatments. Through these interventions, case managers can help patients effect the changes they need in their lives in order to achieve measurable outcomes and improve the quality of their lives. As results are documented and tracked, the connection can be made that illustrates the value of case management in achieving desired outcomes across the spectrum of healthcare delivery.
Schoen et al. (2005). Taking the pulse of healthcare systems; experiences of patients with health problems in six countries. Health Affairs.
Olson, D.P. and Windish, D.M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of Internal Medicine: 170(15): 1302-7.
Commission for Case Manager Certification. (2009). Code of Professional Conduct for
Case Managers. http://www.ccmcertification.org/sites/default/files/downloads/2012/CCMC_Code_of_Conduct%202-22-12.pdf. Accessed February 28, 2012.
Gilfillan R.J., Tomcavage J., Rosenthal MB, et al. (2012). Value and the medical home: effects of transformed primary care. American Journal of Managed Care. 16(8): 607-614.
Tahan, H., and Campagna, V. (September/ October 201). Case management roles and functions across various settings and professional disciplines. Professional Case Management.
Dorothy Consonery-Fairnot, MSHA, RN, CCM, CLNC, (top) is a Commissioner and Chair of the Commission for Case Manager Certification, the largest nationally accredited organization that certifies case managers (www.ccmcertification.org). She is founder and president of Fairnot & Associates Health Care Consulting, LLC. Kathryn M. Serbin, BSN, MS, CCM, is Chair-Elect of the CCMC. She is also Section Chief, Women’s Health Clinic, and Senior Nurse, Surgical Clinics Ambulatory Care Center of the James A. Lovell Federal Healthcare Facility.