THE EFFECTIVENESS OF CASE MANAGEMENT IN THE ACUTE CARE SETTING

Case Management is defined as a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes (Kongstvedt, 2001).

The case management process has been applied effectively in both the acute care and outpatient settings with diverse populations and disease states. There is increasing evidence that use of the case management process in both acute and long-term care settings has led to quantitative and qualitative improvements in health care delivery.

Well-designed case management programs are a key factor in the effective use of hospital resources and are effective in reducing costs (Cudney, 2002; Ramsey, Ormsby, & Marsh, 2001). Additionally, as chronic conditions increase and the population ages, the case management model has even greater potential for improving individual hospital performance and the allocation of health resources nationally.

In the acute care setting, effective case management programs provide the hospital with savings where they

• reduce the level of care,
• decrease length of stay,
• decrease the frequency and duration of services,
• prevent unnecessary bed days and fewer clinical services, and
• reduce associated ancillary charges.

Other potential savings that may occur with the use of a case manager are

• lower hospital re-admission rates,
• fewer emergency department visits, and
• the earlier migration of inpatient hospitalization to home health services.

As discussed by Cudney (2002), case management is also a key factor in increasing quality of care, patient and family satisfaction, patient compliance, and increased quality of life. Additionally, implementation of case management programs supports a total quality management approach, collaboration between care providers across disciplines, and inclusion of family and social support agencies in patient discharge planning (Johnson & Schubring, 1999).

Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) have incorporated case management programs to improve organizational performance. As a result, "case management has been used as a cost-containment strategy for elderly, high-risk enrollees" (Marshall, Long, Voss, Demma, & Skerl, 1999, p. 477), workers' compensation, pharmacy, mental health services, and chronic disease management plans (Ebbinghaus & Bahrainwala, 2003; Green-McKenzie, Rainer, Behrman, & Emmett, 2002; Laramee, Levinsky, Sargent, Ross, & Callas, 2003; Spears, Rihani, & Peard, 2002).

Few organizations have undertaken statistical analyses to provide evidence of case management's effectiveness in containing costs or achieving other measurable outcomes (Marshall et al., 1999). Where readmission rates and other indicators of cost saving have been measured, reports of cost savings are not universal but cost benefits are reported a majority of the time. Again, in the hospital setting, unit-specific programs such as emergency department case management programs have quantifiable savings and improved patient care (Niemi, 1999). Comprehensive measurement and reporting of the impact of hospital-based case management efforts are needed.