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The Impact of Case Management on Reducing Readmission for Patients Diagnosed With Heart Failure and Diabetes

McCants, Khalilah M. DNP, MSN, RN-BC; Reid, Kathryn B. PhD, RN, FNP-C; Williams, Ishan PhD, FGSA; Miller, D. Elise MSN, LNHA, RN; Rubin, Richard MD; Dutton, Suzanne MSN, DNP(c), RN, GNP-BC

doi: 10.1097/NCM.0000000000000359
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Purpose of the Study: To determine the impact of integrated case management services versus treatment as usual (TAU) for patients diagnosed with diabetes and concomitant heart failure.

Primary Setting: This medical chart review was conducted at a single-site facility. The retrospective study design can be implemented at other facilities with a similar landscape.

Methods: A retrospective, descriptive, comparative analysis of integrated case management services compared with TAU from a medical chart review of 68 patients from September 1, 2015, through July 31, 2017. A medical chart review was conducted to generate the study sample for data collection and analysis. The data were organized, cleaned, and prepared and then analyzed. The data were analyzed using SPSS and verified with SAS and R. Applied were descriptive statistics and statistical tests—t test, χ2 test, Mann–Whitney U test, and Logistic Regression.

Results: For the integrated case management group, there were 18.4% who readmitted whereas 81.6% did not. For the TAU group, there were 52.6% who readmitted and 47.4% who did not. The association between readmission and case management was χ2 (1, n = 68) = 6.372, p = .012.

Nursing Implications: Integrated case management services were statistically significant in reducing readmission for the sample. Demographics tested in this study were not significant predictors for readmission. Extending length of stay for patients who are not medically ready for discharge should be considered because there is a cost difference, as there is evidence of readmission reduction. Policy and procedural amendments can be obtained from this study.

Khalilah M. McCants, DNP, MSN, RN-BC, is from School of Nursing, University of Virginia, and competencies that comprise Dr. McCants' nursing philosophy are as follows: (1) ability to design and lead, (2) effective management, and (3) ability to convert data into useful information. As an expert in her field as a nurse leader, Dr. McCants is devoted to making a domestic and global difference in the health of individuals.

Kathryn B. Reid, PhD, RN, FNP-C, is from University of Virginia and is associate professor of nursing. She has received awards for excellence in teaching, innovative teaching strategies, professional service, and leadership as a 2005 Fellow in the AACN Leadership in Academic Nursing Program. Her research focuses on diabetes self-management education, and she maintains an active clinical practice as an FNP.

Ishan Williams, PhD, FGSA, is an Associate Professor at the University of Virginia, School of Nursing. Her current research focuses on quality of life issues among older adults with dementia and their family caregivers, chronic disease management for older adults with Type 2 diabetes, and a study on the link between cognition and vascular problems among older African American adults.

D. Elise Miller, MSN, LNHA, RN, is from Sibley Memorial Hospital. She has health care experience within hospitals, skilled nursing facilities, private insurers, and HMOs. She has a master's degree in nursing and is a Licensed Nursing Home Administrator. Currently, Ms. Miller works at Sibley Memorial Hospital where she has been the Renaissance Administrator since 2010 and the Director of Case Coordination since 2002. Ms. Miller has held case management leadership positions for MAMSI, Kaiser Permanente, and Health Management Strategies. She coauthored the chapter: Managed Care and New Roles for Nursing: Utilization and Case Management in a Health Maintenance Organization, Managing Nursing Care: Promise and Pitfalls, Series on Nursing Administration in 1993.

Richard Rubin, MD, completed his BA and MD degrees at the Johns Hopkins University, and his cardiology training at Georgetown University. He is the Chief of Cardiology at Sibley Memorial Hospital in Washington, DC. He also serves as the hospital's physician advisor for utilization review, clinical resources management, and documentation improvement.

Suzanne Dutton, MSN, DNP(c), RN, GNP-BC, works as a geriatric advanced practice nurse and NICHE coordinator at Sibley Memorial Hospital. She received her BSN, RN, at Fairfield University, MSN, GNP, from Yale University, and is currently enrolled as a doctorate student at Johns Hopkins School of Nursing

Address correspondence to Khalilah M. McCants, DNP, MSN, RN-BC, School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA 22903 (Km2nh@virginia.edu).

Presentation: Scholarly Practice Project presented to the Graduate Faculty of the University of Virginia in candidacy for the degree of Doctor of Nursing Practice.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.professionalcasemanagementjournal.com).

The authors report no conflicts of interest.

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