Case Management Chapter 1 Overview

Questions and Answers

Which is true about the case management definition?

True

In 1990, how did Yee define case management?

the process of getting the right service to the right client

The differences between case management and managed care include:

Case management is people-oriented. (correct)

Managed care is system-oriented. (correct)

Case management is system-oriented.

Managed care is people-oriented.

What do definitions of managed care typically include?

insurance benefits, limitations, and exclusions Signup and view all the answers

What milestone does case management evolution include?

insurance companies coordinate services for soldiers post-World War II Signup and view all the answers

During the late 1990s to early 2000s, case management was practiced in every setting across the healthcare continuum.

True Signup and view all the answers

The case management training methods are included in the factors that impact models of case management.

False Signup and view all the answers

What is the 'Acute Care Case Management Model' typically characterized by?

episodic and time-limited care in the hospital setting Signup and view all the answers

Patients requiring short- or long-term management services are included in the?

Large Case Management Model Signup and view all the answers

What do 'Disease Management Model' case managers apply?

evidence-based guidelines or protocols Signup and view all the answers

For a foster child target population, who is the best choice for a case manager?

a social worker Signup and view all the answers

How do social worker case managers differ from nursing case managers?

focus more on the patient's complex discharge planning and financial needs Signup and view all the answers

For over five years, what was recommended regarding the nurse case manager-social worker team?

place nurse case managers and social workers under one department Signup and view all the answers

Strategies to ensure effectiveness of the case management model include all of the following except:

Prioritizing goals from the patient's family's points of view for reimbursement needs. Signup and view all the answers

When a case management model is not adequate, what should be evaluated?

the organization's geographic location Signup and view all the answers

What should be assessed when collecting and analyzing data for case management model effectiveness?

recidivism Signup and view all the answers

For evaluation of a model, metrics should be determined based on what?

the goals and expectations of the model Signup and view all the answers

What is telehealth?

the provision and management of healthcare services from a distance Signup and view all the answers

Examples of telehealth management include all of the following except:

In-person visits. Signup and view all the answers

Which is true about the use of current information systems with case management?

True Signup and view all the answers

Study Notes

Case Management Overview

Numerous definitions of case management exist, formulated by various professionals and organizations.
Yee (1990) defined case management as "the process of getting the right service to the right client."

Case Management vs Managed Care

Case management is people-oriented, focusing on individual needs, whereas managed care is system-oriented, concentrating on efficiency and cost containment.

Managed Care Definitions

Managed care includes terms related to insurance benefits, limitations, and exclusions.

Historical Context of Case Management

Post-World War II, insurance companies began coordinating services for soldiers, marking a significant milestone in case management evolution.
By the late 1990s to early 2000s, case management practices expanded across all healthcare settings.

Factors Influencing Case Management Models

Training methods for case managers are not considered a factor impacting models of case management.
The "Acute Care Case Management Model" typically involves episodic, time-limited care within hospital environments.

Case Management Models

The "Large Case Management Model" is tailored for patients with chronic illnesses, disabilities, or catastrophic conditions needing ongoing management.
In the "Disease Management Model," case managers utilize evidence-based guidelines or protocols to inform care.

Role of Case Managers

For a foster child target population, a social worker is identified as the most suitable case manager.
Social worker case managers differ from nursing case managers by emphasizing complex discharge planning and addressing financial needs of patients.

Team Dynamics in Case Management

Recommendations arising from legal actions involving nurse case managers and social workers suggested integrating both roles under a single department to enhance collaboration.

Effectiveness of Case Management

Strategies for case management effectiveness exclude prioritizing goals based solely on the patient family's reimbursement needs.
Evaluating an inadequate case management model involves assessing the organization's geographic location and the impact of recidivism.

Metrics for Evaluation

Metrics for evaluating a case management model must align with the specific goals and expectations set for that model.

Telehealth in Case Management

Telehealth refers to the distance-based provision and management of healthcare services.
Telehealth management examples do not include delivering direct patient care in traditional office or hospital settings.

Information Systems in Case Management

McGonigle and Mastrian assert that current information technology systems will offer solutions to enhance case management practices.

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Description

This quiz covers key concepts from Chapter 1 on Case Management. It explores various definitions and distinctions between case management and managed care. Test your understanding of the fundamental aspects of case management as defined by professionals in the field.