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An Evidence-Based Approach to Case Management Model Selection for an Acute Care Facility: Is There Really a Preferred Model?

Terra, Sandra M. MS, BSN, RN, CCM, CPUR

doi: 10.1097/01.PCAMA.0000271365.01171.b6
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Purpose of Study This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another.

Primary Practice Setting(s) Acute Inpatient Hospital.

Methodology and Sample This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence.

Conclusion This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice.

Implications for Case Management Practice Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates:

  • The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase.
  • The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy.
  • Acute care case management programs reduce cost, LOS, and improve outcomes.
  • An integrated case management program that includes social workers, as well as nursing, is the most effective acute care case management model.
  • The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

Sandra M. Terra, MS, BSN, RN, CCM, CPUR, is the Director of Case Management for Memorial Hospital in Jacksonville, FL, a 340-bed acute care facility. In addition to 10 years of clinical nursing experience, she has more than 20 years of case management administration experience in the acute, military, and managed care settings to draw upon.

Address correspondence to Sandra M. Terra, MS, BSN, RN, CCM, CPUR, Memorial Hospital Jacksonville, 3625 University Blvd South, Jacksonville, FL 32216 (Sandra.Terra@HCAHealthcare.com)

Acknowledgement is given to Doctor of Health Science Program Evidence Based Medicine course, Health Professions Division, Nova Southeastern University, and Dr Patricia Kelly for guidance and support during the research and writing of this article.

© 2007 Lippincott Williams & Wilkins, Inc.