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Case Management BasicsPublic Health Nursing Population Centered Health Care in the Community

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___________ management includes wellness and health promotion, illness prevention, acute and subacute care, rehabilitation, end-of life care and care coordination.
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Population
How has the use of integrated health systems had important impact on the focus of care? (4)
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-emphasis has changed to health management as opposed to episodic management -management of care has shifted from inpatient care to primary care physicians as points of entry -care management services and programs have allow for accountability and access -outcomes are measured on a systems level (as opposed to on a person-by-person basis)
What are the major activities of population health management? (6)
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1-assess the needs of the client population 2-create benefits and networks to meet the identified needs 3-prioritize actions to produce a positive outcome with resources available 4-select programs related to wellness, prevention, health promotion, and demand management and educate the population about them 5-institute a care management process that coordinates care across the health continuum for the population aggregate 6-assign case managers to clients and to PCP
How are the needs of a client population assessed?
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Through health histories, genotypes, claims, use of service patterns and risk factors
What is critical to achieving the goals of population management?
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Establishing a relationship between financing, managing, delivering and coordinating services
What is a social mandate?
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With respect to HP 2010, it is the goal to increase quality years of life and decrease disparities in care across all cultures and ethnicities.
________ management is the process in which a population manager establishes systems and processes to monitor the health status, resources and outcomes for a targeted aggregate of the population.
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Case management
What are the building blocks utilized by a case manager to successfully achieve their goals?
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Risk analysis Data mapping Monitoring for health processes, indicators and unexpected illnesses Epidemiologic investigations of unexpected illnesses Development of multi-disciplinary action plans and programs Identifying case management triggers that indicate the need for referral in high risk clients
What is a case management trigger?
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It is the evidence of dramatic results from a prevention or early intervention (i.e. an education class that dramatically reduces the number of occupational accidents could be a trigger for educating all employees within a factory with the same program)
Who initially developed care management strategies? Why?
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HMO's (Health Maintenance Organizations)to promote quality, ensure appropriate use and cost of services and to manage care of different populations.
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What are the care management strategies? (4)
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Utilization management Critical pathways Disease management Demand management
___________ management attempts to promote optimal use of services to redirect care and monitor the appropriate use of provider/treatment services for both acute and community/ambulatory services.
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Utilization
Offering providers multiple options for care with different economic implications and referring clients with repetitive admissions to a care management programs are activities seen in ____________ management.
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Utilization
_________ are tools that specify activities providers may use in a timely sequence to achieve desired outcomes for care.
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Critical pathways
What are the goals/benefits of critical pathways?
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Strives to provide standard care (reduce differences) and provides measurable outcomes
___________ management services are used for clients with specific diagnoses who may have high use patterns, noncompliance issues, cost-caps or threshold expenses.
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Critical pathway
_________ management uses treatment guidelines to streamline the processm avoid unnecessary care, and act proactively to slow and/or reduce the effects of complications or illness process for populations.
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Disease
Which management style targets chronic and costly conditions that require long-term care interventions like asthma, diabetes and depression?
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Disease management
________ management organizes services across the continuum of primary, secondary and tertiary interventions as well as self-care management.
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Disease
__________ management seeks to control use of health care services by providing clients with correct information and education strategies to make healthy choices, use healthy and health seeking behaviors to improve their health status and to have fewer needs of the health care system.
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Demand management
  
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