When reflecting upon the changing models of healthcare, which take center stage in this week’s clinical news, the words of the villainous Edmund in Shakespeare’s King Lear came to mind, as some efforts that were put into motion 30 years ago in U.S. healthcare are starting to come to fruition.
The term "case management" first appeared in the social welfare literature in the early 70s and then later appeared in nursing literature (ANA, 1988). While the model became an innovative term in the 80s, only now does it seem to be gaining the backing of the providers who are trying to stay ahead of changing reimbursement trends.
Positive clinical outcomes are emerging to support these efforts. Researchers who published a recent study in the Cochrane Library demonstrated that among chronic heart failure (CHF) patients who have previously been admitted to the hospital for this condition there is “now good evidence” that case management-type interventions led by a HF specialist nurse reduces CHF related readmissions after one year of follow-up, all-cause readmissions and all-cause mortality.
They compared the case management interventions (intense monitoring of patients following discharge often involving telephone follow-up and home visits) with clinic interventions (follow-up in a CHF clinic) and multidisciplinary interventions (holistic approach bridging the gap between hospital admission and discharge home delivered by a team). Across most of the pre-established endpoints, nurse-led case management proved the most effective for patient outcomes.
A follow-up question about how to make this model cost effective will need to be explored.
Likewise, a study issued this week in the Annals of Internal Medicine found that hospital-initiated transitional care can improve some outcomes in adults hospitalized for stroke or MI.
“When done properly, transitional care should be based on a comprehensive care plan and the availability of healthcare providers who are well-trained in long-term care and are armed with information about the patient’s goals, preferences and clinical status,” Susan T. Bray-Hall, MD, from University of Colorado School of Medicine in Denver, wrote in the accompanying editorial. “Well-executed transitions should include logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition.”
When recently speaking with a cardiovascular nurse practitioner from Stanford for an upcoming article in Cardiovascular Business, she also stressed the necessity of following patients to their places of residence and speaking with family members in order to truly treat the patient in a personalized, effective manner. Home visits, which may seem antiquated, are becoming an integral part of this transitional care model.
Hopefully, unlike Edmund in King Lear, this evolution of healthcare back to some core models will result in more positive implications. His intent at the beginning of the play may result for healthcare: “I grow, I prosper.”
On these topics, or any others, please feel free to contact me.