Care Del Methods
This is considered oldest mode of organizing patient care
delivers cost-effective, primary care, utilizing care coordination, ensuring high value and improving health outcomes
What is Patient-Centered Medical Home (PCMH)?
a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and the use of available resources to promote quality and cost-effective outcomes.
A change from a focus on a single provider caring for the health and well-being of an individual patient to a focus on a health-care team managing the health of a panel of patients
The greatest disadvantage of total patient care delivery
the establishment of the Patient-Centered Medical Home
Patient Protection and Affordable Care Act (PPACA)
integrates utilization management and discharge planning functions and may be unit based, assigned by patient, disease based, or primary nurse case managed.
A thorough knowledge of chronic disease management and evidence-based guidelines and protocols, especially for chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), diabetes, and depression (order sets/standing orders)
What is Comprehensive assessment and care planning?
“Care through others” became the phrase used to refer to this method of nursing care
interprofessional teams that include, but are not limited to, physicians, nurse practitioners, nurses, physical therapists, occupational therapists, and social workers who work collaboratively to deliver coordinated patient care. (team nursing)
What are primary health-care teams (PHCTs)?
Case managers often manage care using these plans
What are critical pathways and multidisciplinary action plans (MAPs)?
The care MAP is a combination of a critical pathway and a nursing care plan. In addition, the care MAP indicates times when nursing interventions should occur. All health-care providers follow the care MAP to facilitate expected outcomes. If a patient deviates from the normal plan, a variance is indicated. A variance is anything that occurs to alter the patient’s progress through the normal critical path.
A thorough familiarity of public and private community-based providers, services, and support available in the local geographical area
duties may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities.
this group defined this as “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”
What is the Case Management Society of America (CMSA)?
A basic understanding of research and evaluation techniques to assist in quality improvement of care and interpretation of program outcomes.
patient care units are typically divided into modules or districts, and assignments are based on the geographical location of patients.
One role that is increasingly assumed by case managers is coordinating
A working knowledge of adult education principles and learning techniques, readiness to change, and identification of necessary person-centered components for a self-management plan