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Study Guide

[NURS 371] - Final Exam Guide - Everything you need to know! (201 pages long)


Department
Nursing
Course Code
NURS 371
Professor
Heather Mitchell
Study Guide
Final

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UofL
NURS 371
FINAL EXAM
STUDY GUIDE

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Case Management of the Adult Patient
I. Definition
“A collaborative process of assessment, planning, facilitation and advocacy for
options and services to meet an individual’s health needs through communication and
available resources to promote quality, cost-effective outcomes” (Case Management
Society of America)
II. Driving Forces
a. Changes in reimbursement systems – ACA, push to move impatient to outpatient
b. Increasing aging population - Baby Boomers are the largest group of people
c. Increasing number of complex, chronic disease states – Diabetes, COPD, CHF,
etc.
d. Consumer demand – People are becoming more knowledgeable to the care they
deserve/ need
e. Advanced technology – More available than ever before
e.i. Expense r/t technology
e.ii. Medications, medical treatments, surgery, information
f. Increased numbers needing access to diminishing resources – More people
needing access to less resources
III. Patients’ Perspective
a. Confusing system – Healthcare in general is complex
b. Conflicting information - often health insurance companies only allow the bare
minimum of care, affecting patient outcome and future needs for healthcare
access
c. Lack of knowledge and information – patients are unsure what to ask, what they
need to know
d. Many “assume” the healthcare provider knows best and knows what they should
know - assume the healthcare team tells them everything and it is unchanging
e. A frustrating and fragmented systemCardiologist, pulmonologist, PCP,
surgeon, etc often have conflicting orders and do not know the other’s courses of
treatment
IV. Purpose
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a. Care Coordination – from start to finish of when patient needs care
b. Financial Management– making sure the same procedures are not done over and
over – repeat CT scans, MRIs, etc.
c. Resource Utilization – using resources
d. Cost Effective Outcomes – the goal is to keep patients healthy and out of the
hospital
e. Advocacy – we want our patients to have good outcomes
f. Communication – working in unity with health care team
g. CM starts when patient begins receiving care until he or she is no longer receiving
the services.
h. Focuses on managed care of the client through collaboration of the health care
team.
V. Goals of Case Management
a. Primary goal- avoid fragmentation of care and control cost
b. Case Management targets:
c. Quality healthcare across a continuum – subpar care breeds subpar results
d. Increased quality of life
e. Utilization of resources – cheaper to use glucometer than to go to ER
f. Cost containment – if core measures aren’t done, no reimbursement is given
g. Efficient and effective delivery of care
h. Patient wellness and autonomy
Healthcare team: Patient and family, case manager, physician, employer, members of healthcare
team, providers, community, payer, social worker, etc, etc.
VI. Nursing Role in Case Management
a. Coordinating care especially for those with complex healthcare needs
b. Representative of the client and as a liaison when collaborating with the provider
and other members of the healthcare team
c. Client advocate by protecting the rights of clients and ensuring that client needs
are met
d. As the coordinator of care, the nurse is responsible for:
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