NURSING CASE
MANAGEMENT
A COMMUNITY and
PUBLIC HEALTH MODEL
By Nataliya Haliyash,
MD, BSN
TSMU, International Nursing School
Introduction
Case Management model designed for use in:
 population approach
 community setting
 complex clients (disease management)
Nurse case management - a strategy
for care co-ordination
“ A role and process that focuses on
procuring, negotiating, and coordinating the
care, services, and resources needed by
individuals with complex issues throughout
an episode or continuum”
Bower, K. (1996)
Case management
strategy to coordinate care through a process
of managing quality, access, and cost to
manage the risks with vulnerable groups.
(Yoder-Wise, 1999)

It involves face-to-face relationships across a
variety of health care agencies and services
and their representatives.
Case management

is an area of practice within several healthcare
professions. Most case managers are nurses or
social workers.

The term case management is also used to refer to
dispute resolution systems which provide court or
tribunal officials with closer administrative control
over the litigation process than is traditionally
associated with common law litigation.
Case management
The Case Management Society of America
defines case management 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 costeffective outcomes."
Case Management goals:
Enhance health status and functionality of
clients;
 Maximize client access to services;
 Use resources cost-effectively;
 Integrate & coordinate services provided by
multiple disciplines

Cohen (1996)
Five Principles of
Nursing Case Management
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Focuses on clients and families with complex issues
Involves negotiation, coordinating, and procuring
services and resources
Entails using a clinical reasoning process
Network development of multi-disciplinary relationships
Is episode- or continuum-focused
Cohen, E (1996)


For community health nurses, this has been
the method of caregiving for more than 100
years.
However, it was introduced in the acute care
setting, with enthusiasm, in the 1990s as a
“delivery innovation” and a panacea for
harnessing escalating costs and insurance
premium increases.
(Powell, 2000)
Hospital
Sanatorium
Community
Nurse case management in the
Community Setting

Health promotion & disease prevention

Prevent escalation of client condition

Comprehensive & collaborative care

Efficient use of health care services

Practice guidelines, clinical pathways &
client/family outcomes improve effectivity
The Case Management Process
Case finding & risk appraisal
 Nursing interventions matched against
characteristics & needs of the risk group
 Co-ordination of services & continuum of
care
 Evaluation of individual & group outcomes

Bower, K. (1992) & Mullahy, C.M. (1995)
WIDER COMMUNITY
WORK & PLAY
WHANAU
CLIENT
HOSPITAL
MO’S/PHMS
OTHER PHN’S
SOCIAL AGENCIES
NURSE
NURSE
Strengths
Good collaboration –
nurse/client/doctors/services
 Focuses on prevention
 Highlights health promotion
 Treatment becomes an integral part of daily life
for our client

Weaknesses
Dependent upon individual nurses’
skills/perseverance/initiative
 Educational requirements vs the demands
of the role
 Nurses often feel ill-prepared to offer basic
instruction/support in health promotion &
prevention

Optimum Example
Benefits & Outcomes
Question:
 Where on the continuum do the clients access
services?
 How do we measure prevention?
 How do we measure health promotion?
 What changes are needed to realise these
benefits?
Why measure outcomes?
 Dramatic
shifts in health care delivery is
being driven by changes in reimbursement
 It is more cost effective to treat populations
by using epidemiological and public health
models rather than treating individuals or
families/whanau
Challenges in Measuring Outcomes

Client confidentiality

I.T. development of user friendly software

Nurse’s need to adapt health care practice
to modern-day technology
 Population-based
care requires healthcare
providers work together
Examples of Outcomes Measurement

Quality Outcomes

Cost Outcomes

Comparison studies to show contrast

Measuring the complexity of needs
Lessons Learned
Central to this model are:
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Collaboration
Networking
Keeping the client & family/whanau at the centre of care
Public health nurses have become pro-active in the
development of strategies that are core to the health care
management of high-risk populations eg. Case
management
Multi-disciplinary team approaches
National and International planning
Bibliography
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Bower, K. and C. Falk (1996). Case Management as a Response to
Quality, Cost, and Access Imperatives. Nurse Case Management in the
21st Century. E. Cohen. St. Louis, Mosby: 161-166.
Cohen, E. (1996). Nurse Case Management in the 21st Century. St Louis,
Mosby.
Cohen, E. and T. Cesta (1997). Nursing Case Management; from concept
to evaluation. St Louis, Mosby.
Donabedian, A. (1990). “The Seven Pillars of Quality.” Arch Pathol Lab
Med 114: 1115 - 8.
Etheredge, M. L. (1989). Collaborative Care Nursing Case Management.
(American Hospital Association), American Hospital Publishing, Inc.
Kersbergen, A. L. (1996). “Case Management: a rich history of
coordinating care to control costs.” Nursing Outlook 44(4): 169-72.
Zander, K. (1990). Patient Care Delivery Models. Rockville, MD: Aspen
Publishers.
External links
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Case Management Software Solution
http://www.handelit.com/
Commission for Case Manager Certification
Case Management Society of America
American Case Management Association
http://www.acmaweb.org/
Case Management resources
On the Case from minoritynurse.com
He aha te mea nui ki te
Ao?
What is the most
important treasure on
earth?
He tangata,
he tangata,
he tangata
It is people
It is people
It is people