Key Elements of Case Management

1. Key Elements of Case Management Charlton Wilson MD SDPI Competitive Grant Program Cardiovascular Disease Risk Reduction Group Planning Year – Meeting 1 November 18-19, 2004 Denver, CO

2. Outline • Definitions • Experience in American Indian and Alaska Native communities • Models • Issues to address • Resources

3. Self management   Self Management Education Health-care system level interventions Disease Management Case Management To improve diabetes care, Task Force on Community Preventive Servicessupports the following interventions: The Task Force on Community Preventive Services is a 15-member non-Federal Task force supported by the Centers for Disease Control and Prevention (CDC).

4. Diabetes Self-Management Education • Structured education programs • self-monitoring of blood glucose • education about diet and exercise • treatment plans • motivation for patients to use the skills for self-management of diabetes.

6. Disease Management • Organized, proactive, multi-component approach for all members of a population with a specific disease • identify the target population in the community or organization • implement care plans proven to be effective • track, measure, and manage health outcomes

8. Case Management • Assignment of a case manager to • Plan • Coordinate • Integrate care for people with a disease or condition

10. Models

11. Models

12. Models • Position Requirements • Often Nursing background • Key Activities • Identification and outreach to patients • Assessment • Care plan development • Care plan implementation • Follow up • A Case Management Outcome • Defined areas of empowerment

13. Outreach Effectiveness PIMC, Case Management Pilot Project, ADA 2001 Chi2 for trend 9.6, p = 0.002

14. Issues • Roles and Responsibilities • Professional relationships • Accountability • Space, tools • Location • Registry Access • Case Load Management • Continuous healing relationships vs dynamic patient populations • Those issues unique to your community

15. Selected adjusted* process measure outcomes of interest among patients included in the evaluation cohort at PIMC, IHS, 2001-2002 Adjusted for age, sex, treatment type, BMI

16. Selected adjusted treatment pattern differences among patients included in the evaluation cohort at PIMC, IHS, 2001-2002. * Adjusted for age, sex $ Analysis restricted to 736 of the patients in the evaluation cohort with a clinical diagnosis of hypertension & Analysis restricted to 594 of the patients in the evaluation cohort with a low density lipoprotein cholesterol of > 2.58 mmol.L (100mg.dL) # Adjusted for age, sex, treatment type

17. Resources • Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, Jack L, Isham G, Snyder SR, Carande-Kulis VG, Garfield S, Briss P, McCulloch D: The effectiveness of disease and case management for people with diabetes. A systematic review. Am J Prev Med 2002; 22:15-38. • Wilson, C, Curtis J, Lipke S, Bochenski C, Gilliland S, Description of the Case Load and Apparent Effectiveness of Nurse Case Managers in a Large Clinical Practice: Implications for Workforce Development, Diabetic Medicine 2005, (in press)

18. Summary • Definitions • Experience in American Indian and Alaska Native communities • Models • Issues to address • Resources