Is Case Management an Efficient and Effective Model of Care for Complex Patients in an Acute Medical Setting?

Abstract

This thesis looks at the prospect of developing and implementing Case Management as a model of care for complex patients in an acute medical setting. An extensive literature review was conducted to explore the concept of Case Management and to identify the role of the Case Manager, including the qualities and qualifications required for the position. Clinical Pathways are a tool used in Case Management so these are also included in the literature review. As I had been involved in the development of the first Clinical Pathway for Hutt Valley Health, this is used as an example to clarify how Case Management and Clinical Pathways can be used in conjunction. Taranaki Healthcare have four Case Managers and have developed 20 Clinical Pathways Therefore, ethical approval was sought from both Hutt Valley Health and Taranaki Healthcare to use documentation, from these health organisations, to undertake this research. A discussion chapter examines the advantages and disadvantages of Case Management which shows that Case Management can be an effective and efficient model of care through the development of Clinical Pathways. The ethical implications of Case Management are also considered. The thesis concludes with recommendations for the continued development of Case Management as a model of care to improve the quality of care for both patients and the organisation. During the course of the thesis, other areas that are worth further investigation have also been identified, such as the relevance of Case Management to different cultures. This does not appear to be in the literature at present. The thesis suggests that a proposal for Case Management for complex patients in the Acute Care setting is developed along with a job description for the role of the Case Manager. In my role as Clinical Nurse Consultant for medical services I had been asked to investigate Case Management. The interest in Case Management had been raised from a discharge-planning audit that I had conducted for medical services in 1998. On the day of the audit, ten patients were identified as complex, requiring a longer than expected stay in hospital.