How to measure case management's success
How to measure case management's success
Set goals for each function
Case managers must become more creative in finding quantifiable outcome measurements for their own case management efforts not only in the acute care setting but also throughout the entire continuum of care, says Patrice L. Spath, ART, BA, president of Brown-Spath & Associates, a health care quality consulting firm based in Forest Grove, OR.
"As you move through the entire continuum of health care services, the first issue you will be faced with is, 'How do I capture outcomes information?' Even more of a critical concern is that you need some control over the validity and reliability of the data which you are collecting," Spath says.
One of the first steps in measuring the effectiveness of your own program is to set your goals upfront. Case management goals may be patient-oriented, system-oriented, or a combination of both, Spath explains. For example, "a patient-oriented goal is to assure that the service given is appropriate to meet the needs of a particular patient, or it may be to monitor the patient services to ensure that they receive the appropriate service," Spath says. A systems-oriented goal would be to facilitate the use of a broader array of services.
Your goals will vary, depending upon the setting in which you are working, says Spath. "I find that the goals established for patient management are very dependent upon who pays your check every month."
For example, a case manager working in a payer-based setting may have goals to decrease utilization of services and reduce the risk of nursing home placement, while a hospital-based case manager will set goals to decrease length of stay, prevent unnecessary readmissions, and stabilize the patient referral base.
In essence, goals should be established for each important case management function: assessment/case identification and selection; problem identification; planning; monitoring; and evaluating. "Ideally, your organization has established measurable goals for each one of those functions. There are no right goals. The only wrong ones are those that aren't written down and well established," Spath says.
Spath strongly urges case managers to work with all of the disciplines within their organization to precisely define the goals of case management. Everyone will have different perspectives about the goals, and "of course your boss will then have a totally different idea of what your goals and objectives should be. So, the best thing you can do for yourself is to get everybody who has an impact on case management together, from a leadership standpoint down, to agree on what these priority goals are," advises Spath.
The next step is to define measures of performance. "The measures of performance should have some relationship to your goals and objectives, but don't start with measures and work backward. I strongly encourage you to start with goals and work forward," Spath cautions. Measures of performance can be a combination of process measures and outcomes measures, defined as follows:
* Process measures.
"Process measures are measures of performance that answer the question, 'Are we doing the right thing?'" Spath says. For example, a process measure may be the number of patient assessments completed within X hours of order as a percent of total cases reviewed, or the number of patients meeting intervention criteria who are not visited within X hours of admission as a percent of total interventions.
* Outcome measures.
"A case management outcome is something that is measurable and expected. This means you want to find out upfront, even before you start your case management program, what outcomes you expect. When you assess a patient, you are going to define at that point the outcome you expect," Spath says. (For more on expected case management outcomes, see the related story, above.)
Case managers at St. Francis Medical Center in Cape Girardeau, MO, are just beginning to measure their own outcomes using some of the methods that Spath describes.
"The reasons that we're doing this are to position ourselves both internally for continuous quality improvement purposes and externally to better position ourselves for managed care," explains Pauline Elliott, RN, service director, who oversees some of the case management functions for the 264-bed regional referral facility.
Although the level of managed care penetration currently is low in Elliott's market, the hospital began embracing quality outcomes concepts in an attempt to be proactive and ready for the changes to come, Elliott says.
"We've had the opportunity to benefit from some of the lessons learned in other regions where [managed care] is much more prevalent. This has helped us get some information ready, so that we cannot only be cost competitive, but also show that we do have quality outcomes," explains Elliott.
Elliott knows the process of collecting case management outcomes data is going to be rigorous, but the facility is taking the process in logical steps. Last year, St. Francis became a patient-focused care facility. Case management was already in place in some areas prior to that, but care coordinators were at various levels of implementation. Now, some care coordinators are unit-based, while others cover the continuum of care, depending on the patients they follow, Elliot says.
"We are very much in the early stages [of measuring outcomes], and we will be evolving this process across time. We realize that we can't turn around information until we've collected data for a while and that this process takes the dedication of both human resources and technology resources," she says. *
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