Name of the Procedure:

Case Management, each 15 minutes
Common name(s): Case Management
Technical/Medical term: T1016

Summary

Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's comprehensive health needs. It involves communication and resources management to promote quality and cost-effective outcomes.

Purpose

Case management aims to help patients with complex health needs navigate the healthcare system, ensure they get appropriate care, and improve their overall health outcomes. Goals include enhancing patient well-being, improving self-management skills, and helping patients achieve their health goals.

Indications

• Chronic illnesses (e.g., diabetes, heart disease, COPD)
• Frequent hospital admissions or emergency room visits
• Complex healthcare needs requiring coordination among multiple providers
• Patients who need help accessing community resources or support services

Preparation

No specific preparations are generally required for case management. However, patients may be asked to:

• Gather relevant medical records and information about their health history
• Make a list of their current medications and health concerns
• Identify their health goals and any barriers they face in managing their health

Procedure Description

1. Assessment: The case manager conducts an initial comprehensive assessment of the patient's medical, psychosocial, and functional needs.
2. Care Plan Development: A personalized care plan is developed, incorporating the patient’s goals, identified risks, and required services.
3. Coordination & Facilitation: The case manager coordinates with healthcare providers, schedules appointments, arranges transportation, and ensures the patient receives necessary services.
4. Monitoring & Evaluation: Regular follow-ups are conducted to monitor the patient’s progress, evaluate the effectiveness of the care plan, and make necessary adjustments.

Duration

Each session of case management is typically scheduled in 15-minute increments. The overall duration of case management services can vary based on the patient’s needs.

Setting

Case management can be performed in various settings including hospitals, outpatient clinics, community health centers, or remotely via telehealth.

Personnel

Case management is usually conducted by professional case managers, who may be nurses, social workers, or other healthcare professionals specialized in care coordination.

Risks and Complications

There are no direct medical risks associated with case management. However, ineffective case management could lead to:

• Miscommunication between healthcare providers
• Inadequate follow-up on care plans
• Unaddressed patient needs

Benefits

• Improved health outcomes
• Better management of chronic diseases
• Enhanced patient satisfaction and self-management
• Reduced hospital admissions and emergency room visits
• Access to necessary community resources and support services

Recovery

There is no physical recovery required for case management. Patients may feel better supported and more confident in managing their health over time.

Alternatives

• Self-Management: Patients manage their health and coordinate their own care.
  • Pros: Greater independence
  • Cons: May be challenging for those with complex needs
• Primary Care Coordination: Coordination of care by a primary care physician.
  • Pros: Centralized care approach
  • Cons: May not provide the same level of dedicated support and advocacy as specialized case management

Patient Experience

Patients can expect to engage in detailed conversations about their health, goals, and challenges. The process is designed to be supportive, with the case manager advocating for the patient’s needs and ensuring they feel understood and assisted throughout their healthcare journey. Pain management and physical discomfort are generally not relevant concerns in case management.