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Quantifying Case Management Workloads: Development of the PACE Tool

Balstad, Amy MS, RN; Springer, Pam PhD, RN


In 1999, the Clinical Resource Management (CRM) group at Saint Alphonsus Regional Medical Center in Boise, Idaho, implemented a specialty-based nursing case management model for individual caseload assignment of all inpatient admissions. This model assigns caseloads by proportion determined by physician specialty type. This model does not consider patient acuity and may have weaknesses associated with self-report. In addition, time requirements for effective case management outcomes are not always reflected in admission volumes alone. This article describes the development and pilot testing of the Patient Acuity Case management Evaluation (PACE) measurement tool. Five phases of methodological development are discussed: (1) conceptualization phase, (2) content development, (3) Delphi technique using expert opinion and critique, (4) inter (intrarater reliability testing, and (5) pilot testing of acuity tool. Examples of instrument development throughout these phases are included. This instrument is expected to provide verifiable measurement of individual and group case management workload.

Amy Balstad, MS, RN, currently a project manager for outpatient oncology services, designed and implemented this study in conjunction with Saint Alphonsus Regional Medical Center and Boise State University.

Pam Springer, PhD, RN, is associate dean of the college of health sciences and chair, department of nursing. She teaches in the areas of leadership and management and has research interests in leadership and informal caregiving.

Address correspondence to Amy Balstad, MS, RN, Project Coordinator, Mountain States Tumor Institute, 100 E Idaho St, Boise, ID 83712 (

Sincere appreciation is given to the following people for their participation in this project: Clinical Resource Management department at Saint Alphonsus Regional Medical Center in Boise, Idaho; Delphi participants within the Trinity Health systems located in Pontiac, Michigan; Ann Arbor, Michigan; Mason City, Iowa; and Livonia, Michigan.

The authors have no conflict of interest.

© 2006 Lippincott Williams & Wilkins, Inc.