Case management: managing the nurse case manager

Nurse executives and nurse managers have become proactive in response to the health care crisis by creating and implementing innovative health care delivery models such as nursing case management. Nursing case management utilizes a nurse as case manager and the unit-based system of managed care to achieve financial and clinical outcomes for target patient groups. Nurse managers can support the nursing case management model best by practicing good managerial skills, developing a participative style of leadership, and empowering the nurse case manager.     

Impact of school nurse case management on students with asthma

This project determined asthma prevalence in a large school district, absentee rates, and potential effects of school nurse case management for student asthma over three years. Data were derived from an asthma tracking tool used by nurses in one school district for every student reported as having asthma by their parent. School nurses began collecting data in their schools in 1999-2000 when an asthma-management protocol was first developed. Nurses documented perceived asthma severity for each student, presence of medication and peak flow meters in school, and case management activities provided. This data base was cross matched with percentage of days students were absent for any illness. Prevalence of asthma, based on school nurse records of parent report, was between 5.1% to 6.2% during the three years. Between 13.5% and 15% were moderate or severe. Students with asthma were absent between one-half to one and one-quarter days more often than those without asthma. In year three, 39% of students with asthma had medication at school, and 12% had a peak flow meter. Contacting a parent was the nurse case management activity provided for the largest number of students (27% of students with asthma), followed by asthma education (16.5%), contact with physician (6%), and home visits (1%). Students who received at least one school nurse case management intervention were more likely the next year to have an asthma medication at school, to use a peak flow meter at school, and to have a change in asthma severity. School nurse case management activity had no association with student absences. Availability of medication and peak flow meters at school was low, suggesting standards of care for asthma were not followed. School nurse case management, when performed outside a project or intervention, offers a promising strategy to improve asthma management.     

Hospital group saves money with data on nurse case management

When most health care organizations think about acute care, they think in episodic terms. But one small group of hospitals anticipates that by extending data collection outward, it can improve patient care and save money at the same time.     

Intervention of the case management nurse in hospital admissions of patients with HIV infection

In countries with access to antiretroviral treatment such as ours, HIV is a chronic disease both characterized for being treated only in hospitals and for the aging of the affected population, the persistence of opportunist infections, the complexity of the antiretroviral treatment, the frequency of adverse effects due to therapies, drug interactions and the high costs of this disease for the Healthcare System. This could justify the need for the creation of the position of nurse case manager to monitor patients with HIV infection, admitted to conventional hospital wards, as a unifying element of the individual's needs and coordinate resources through proper planning and care management.     

Prediction of prolonged work disability in occupational low-back pain based on nurse case management data

This study evaluated whether risk prediction data captured by nurse case managers (NCMs) could predict prolonged disability from occupational low back pain. Cases of uncomplicated occupational low back pain referred to NCMs, with dates of injury between January 1, 1997 and June 30, 1998, were selected (n = 986). Predictive information was obtained from the NCM screening checklist of potential risk factors and other administrative claims data. Data were collected on 23 variables thought to predict work status at 6 months postinjury. In a multivariate logistic regression model, being out of work was significantly associated with older age, language barriers, earlier referral to NCM, and neutral or negative attorney attitude toward return to work. The overall predictive power of the model was low (area under curve = 0.6). Although NCM risk factor data collection is feasible and practical in insurance settings, future studies should explore additional variables and refined data collection methods in order to achieve a more accurate prediction.     

Multistate worklife expectancies

This communication reviews the demographic concept of worklife expectancy and draws the epidemiologists' attention to its usefulness in occupational health research and pension policy making. The distinctions between different analytic approaches to the quantification of expected workforce status and mobility are pointed out. A recently developed multivariate large-sample regression method for the analysis of worklife tables is placed into the general context of life tables. Given aggregated data from multiple cross-sectional or longitudinal population surveys, a multistate regression model can be used to estimate consistently marginal probabilities that a person is in a given work-health state or transition probabilities between the states and, thereby, worklife expectancies. The methodology is illustrated through the application to data from Finnish population statistics on employment, disability, retirement, and mortality. The paper closes with a discussion of the methodological issues and empirical findings on pension policy in Finland.     

Multistate quantile regression models

We develop regression methods for inference on conditional quantiles of time-to-transition in multistate processes. Special cases include survival, recurrent event, semicompeting, and competing risk data. We use an ad hoc representation of the underlying stochastic process, in conjunction with methods for censored quantile regression. In a simulation study, we demonstrate that the proposed approach has a superior finite sample performance over simple methods for censored quantile regression, which naively assume independence between states, and over methods for competing risks, even when the latter are applied to competing risk data settings. We apply our approach to data on hospital-acquired infections in cirrhotic patients, showing a quantile-dependent effect of catheterization on time to infection.     

From management competencies to nurse managerial competencies

This article is a literature review that aimed to collect more information about the competencies management, understand the concepts of profile and competencies in the managing people; understand the issue of professional competence and its relationship with the organization's competencies; and finally identify the managerial competencies necessary to work of the nurse on the aspect of the labor market. The literature showed that the concept of competence shows great results when applied in the people management arena. It also can provide in the context of health services, benefits for the organizations and for the professionals and patients. For that, it's required that health services to take the ownership of this knowledge as possibility to achieve better results, as well as educational institutions and nurses that seek for information and training to achieve the challenges of the profession and the labor market.