Implementing Managed Care and Case Management: The Neuroscience Experience

Implementation of an Inpatient Case Management Program in Rural Hospitals

“…Inadequate education is a commonly repeated concern in implementing quality assurance in rural hospitals (Bushy, 1991). It is not unusual for hospital staff to experience difficulty incorporating managed care and case management concepts into actual practice (Marr & Reid, 1992). Implementing such programs in rural hospitals requires ongoing orientation at a variety of staff and executive positions (Sowell & Fuszard, 1989).…”

“…This paper describes the obstacles to and facilitators of implementation learned from those interviews. This information is useful for rural hospitals because, although there are numerous evaluations supporting the effectiveness of the acute-care case management model in urban hospitals (Bejciy-Spring, 1991;Boyle & Ellis 1990;Cohen, 1991;Daly, et al, 1991;Daly, Phelps, & Rudy, 1991;Graybeal, Gheen, & McKenna, 1993;Marr & Reid, 1992;McKenzie, Torkelson, & Holt 1989;Sinnen & Schifalacqua, 1991;Wood, Bailey, & Tilkemeier, 1992;Zander, 1988c), there is little discussion in the literature describing the experience of rural hospitals attempting to implement such a model.…”

Clinical Caremap Development: How Can Caremaps Standardise Care When They Are Not Standardised?

“…Definitions drawn from literature of the early-mid 1990's agree in principle that the caremap presents as a graph or schedule of care activities described on a timeline and performed as part of the patient's treatment by a multidisciplinary team to produce identified outcomes (Blegen, et al, 1995), (Hampton, 1993), (Hill, 1998), (Gordon, 1996), (Marr & Reid, 1992), (Ogilvie-Harris, et al, 1993), (Wilson, 1995), (Zander, 2002). While the format of caremaps has changed over the intervening decades, this general definition is still appropriate.…”

“…The literature suggests they originated in the nursing domain, incorporating and extending the critical pathway method and bringing established project management methodologies into healthcare delivery (Chu & Cesnik, 1998), (Gemmel, et al, 2008), (Zander, 1992). Caremaps are intended to standardise health services by organising and sequencing care delivery, ensuring a standard of care and timely outcomes using an appropriate level of resources (Blegen, et al, 1995), (Bumgarner & Evans, 1999), (Hampton, 1993), (Marr & Reid, 1992). The caremap can also help track variance in clinical practice, as it provides a simple and effective visual method for identifying when treatment or patient outcomes have deviated from the routine evidence-based pathway (Marr & Reid, 1992), (Houltram & Scanlan, 2004).…”

“…Nursing caremaps from the early 1990's contained considerably more text than their contemporary counterparts, and were presented as the sum of two components: (1) identifying patient problems and necessary outcomes within a timeframe which are (2) broken down and described dayby-day as tasks on a critical path, (Marr & Reid, 1992), (Ogilvie-Harris, et al, 1993). Later approaches presented three components: (1) the flow chart diagram; (2) the transitional text-based care map of activities broken down day-to-day, and; (3) the evidence base relied upon in their construction (Houltram & Scanlan, 2004).…”