Case Management Process for Heart Disease
Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. An individual may present to the hospital with weakness, short of breath (SOB), swelling of the extremities, ascites, and breathing difficulties while lying down. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013).
Studies indicate that nurse case management has reduced patient readmissions to the hospital and improved patient’s overall health. Case management uses assessment, planning, facilitation, coordination, and advocacy to meet the needs of the patient and family/caregiver (CMSA, 2014). Using a holistic and patient-centered approach, case managers can address each patient’s specific needs. Communication is vital between the patient/family, physician, case manager, and others departments involved in the care. The five principles that case management functions under include: 1) focus on the patient and family, 2)
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Case managers use this process to coordinate patient care, which influences both care and financial outcomes. The case manager will assess the patient and family/caregivers needs and knowledge on CHF, then provide resources and services to match. The patient is called within 3 days after discharge for education reinforcement and to answer any questions they may have. The case manager will also schedule a follow-up appointment with an outpatient clinic within a week. The patient will be assessed for symptoms associated with CHF and a medication reconciliation may be done (CHRT,
The aim of this report is to provide an overview of chronic heart failure, examining signs symptoms and treatment related to the case study, and the anatomy and physiology of the heart will be discussed, and the pathophysiology of chronic heart failure.
Cohen, E. L., & Cesta, T. G. (2005). Nursing case management: From essentials to advanced practice applications (4th ed.). St. Louis, MO: Elsevier Mosby.
Case Management is to provide support to patients by making sure that they are getting the optimal care. Utilization Management is to maintain the quality of healthcare by ensuring the least costly but most effective treatment plan. However, both Utilization Management & Case Management are working together to prevent unnecessary treatment, duplication of services, long Stay (LOS) in hospital. Evidence Based Practice exists to demonstrate the value of case management and Utilization Management in order to enhance patient-centered care. The call for evidence-based in healthcare make patient’s effective, safe, and efficient. Case management use a team approach such as physicians, nurses, nutritionists, therapies and treatment to improve best
Mcmurray, J. "Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice." HUG - Service de pharmacologie et toxicologie cliniques - Genève. The European Journal of Heart Failure, 5 July 2005. Web. 20 Mar. 2014.
The nursing process is one of the most fundamental yet crucial aspects of the nursing profession. It guides patient care in a manner that creates an effective, safe, and health promoting process. The purpose and focus of this assessment paper is to detail the core aspects of the nursing process and creating nursing diagnoses for patients in a formal paper. The nursing process allows nurses to identify a patient’s health status, their current health problems, and also identify any potential health risks the patient may have. The nursing process is a broad assessment tool that can be applied to every patient but results in an individualized care plan tailored to the most important needs of the patient. The nurse can then implement this outcome oriented care plan and then evaluate and modify it to fit the patient’s progress (Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P., 2011). The nursing process prioritizes care, creates safety checks so that essential assessments are not missing, and creates an organized routine, allowing nurses to be both efficient and responsible.
The focus of this paper is case management. Case management has evolved into a diverse profession which includes many disciplines and is exercised in many settings. Case management involves the process of coordinating multiple services on behalf of clients and has been practiced now for several decades. Many disciplines have engaged in case management and identify themselves as case managers. Case managers work with many populations and settings and play an important role in today’s society. The following analysis explores how case management developed, how it is defined, its components, and how it relates to other nursing care delivery models. All these aspects are reviewed with the purpose to show the importance of case management in the health care organization.
All companies that are connected with the healthcare system encounter multiple problems that are not being resolved. Queens of Bringing Hearts Together is a company that deals with several heart issues and it is open to the public to provide the best care plans, knowledge and heart transplants at affordable prices for patients. The reason why we decided to construct a company based on heart related issues is because this chronic issue is not taken seriously, as it should be. At the moment it is being stated that, “Heart failure is a progressive and disabling medical condition estimated to affect 5.7 million Americans and consumes an estimated total of $27 billion dollars in annual treatment expenditures” (Gellis 2012). The heart related issues
Heart failure (HF) is a complex clinical pathological syndrome characterised by symptom of shortness of breath , fatigue and the sign of rales on chest ascultation and peripheral pitting oedema also termed as sign of congestion. It is caused by the structural and functional diffect of the heart(1) . It is initally characterised by the dysfunction of the levt ventricle which lead to impairing the filling functin of the ventricles or unable to produce enough contractility of the left ventricle to maintain the cardiac output to meet the demand of the peripheira tissue (2). HF is the major globle public health problen causing cardiovascular morbidity and motality with socio-economic burden. (3)
They specifically define case management as “…a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s health needs through communication and available resources to promote quality, cost-effective outcomes,” (Case Management Society of America). Established to formulate a plan that allows a patient to navigate the healthcare system smoothly, case managers coordinate between the patient, their family members, the healthcare team, insurance companies, communities and many others (Moreo). Chris Gibbard, a case manager at Avista Adventist Hospital, said that the priority is to reduce their patients’ amount of time that they spend in the hospital and to work as their advocate on the hospital side of the situation. The key is to focus on the whole person and the delivery of care. The roles and functions of a case manager go well beyond meeting the hospitals requirements and goals and delve deeper into truly working for their client’s
Heart failure is a chronic and progressive disease where the heart muscles fail to properly pump the necessary amount of blood through the body (American Heart Association). According the Center of Disease and Control (CDC), 5.7 million adults are suffering from heart failure and 1:9 cases result in death. Though, heart failure is general term and encompasses three types of heart failure. The different types of heart failure are left-sided heart failure, right-side heart failure, and congestive heart failure and each has distinctive features that define them. Left side heart failure is described as the heart’s failure to pump blood to the body. Right side heart failure occurs when there is an increased build up in fluid as blood is being returned
Educate the client about worsening of heart failure, lifestyle changes and medicines may no longer control your symptoms. A medical procedure or surgery may be necessary at this point.
For those with advanced heart failure, up to 90% will pass away within one year. About 5.8 million people in the US are living with progressive congestive heart failure. In the elderly population, those over the age of 65, there are about 900,000 yearly admissions to the hospital for heart failure in the United States.”
Every day the nursing profession requires problem solving and decision making; and it is a very fundamental part of the nursing process. Because every patient comes with a unique physical, psychological and social challenges demanding the care of a nurse; profoundly trusting the nurse and the healthcare team to solve a crisis or a problem. Weather a clinical nurse or nurse manager, nurse leadership is always about the best outcome for the client. The healthcare system requires a team of professionals to work together to care for clients. Even if the decision making and problem solving process involved a group of different healthcare professionals working as a team; the nurse plays the primary role caring for patients.
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. A Case Manager is a person (as a social worker or nurse) who assists in the planning, coordination, monitoring, evaluation of medical services for a patient with emphasis on quality of care, continuity of services, and cost-effectiveness. ("Definition and Philosophy of Case Management", 2015).
When looking at Dr. Maxwell’s case, it is evident that he is a clear victim of congestive heart failure. Dr. Maxwell’s medical history is the first piece of evidence that he has congestive heart failure. In fact, his medical history is very consistent with the pathophysiology of the disease. According to the Nelms et. al., pre- existing health issues are what lead to the initiation of this disease. 1 Comparing this to Dr. Maxwell’s medical history, we see that he has a long-standing history of coronary artery disease, hypertension, mitral valve insufficiency, and previous myocardial infarction. His history is consistent with the pathophysiology due to the fact that his past medical conditions are conditions in which worsen the condition, and function, of the heart. Moving on, we also discover