Care Management Model Based On My Philosophy

1358 words - 6 pages

Care Management Model Based on My Philosophy

Care Management
A shift from encounter based care to continuums of care is one of the biggest changes occurring in health care today. This change is driven by governmental legislation, payer incentives, and the recognized need by providers and healthcare systems. The lack of coordinated care results in medical errors, unnecessary procedures, and other forms of waste. This also creates higher costs for the patient, lower quality, and produces an unsatisfactory patient experience. A study performed by the Midwest Business Group on Health in collaboration with the Juran Institute revealed that 30% of all health care expenses result from poor ...view middle of the document...

A clinical care pathway is a map of clinical practice for a particular diagnosis. Clinical care pathways provide an effective means to apply quality improvement and quality control principles in the health care industry. Effective clinical care pathways are designed to eliminate variations in the management of patient treatment by simplifying processes making use of reminders and check lists. Evidence based guidelines are used to guide health professionals in the treatment of patients. Clinical care pathways can improve clinical outcomes and quality of care. (Ralston & Park, 2011). Pathways function well for 60 to 80 percent of the population. These patients reflect high-volume case whose care is relatively predictable (Spath, 1994).
Implementation of a Clinical Pathway
Successful implementation of clinical pathways depends on the involvement and investment of both clinical service providers and managers. Engagement of all relevant staff is necessary to ensure proposed aims are achieved, at each stage from pathway adoption, implementation, and maintenance (Evans-Lacko, Jarrett, McCrone & Thornicroft, 2010). Implementation of a clinical pathway begins with the development and the introduction of care guidelines and practices into the day to day operations. Current practice is reviewed and the information is incorporated into the pathway. The process of continuous improvement allows for potential risks to be identified and procedures to be implemented to minimize them. Documentation must be accurate in order to observe any variation from the pathway (Ralston & Park, 2011). Analysis of variation provides valuable information on improving performance. Clinical care pathways also provide information which allows the cost of care to be tracked and managed through continuums of care. They improve clinical outcomes by reducing errors and ineffective practice. They are an essential tool in coordinating and managing clinical resources (Ralston & Park, 2011). Knowledge in the pathway is always updated through continuous improvement and provides enhanced learning opportunities to new staff of all disciplines. It is imperative that clinical care pathways be focused on the need to improve the quality of care and outcomes. They should be used just as a tool to keep costs down. The care pathway incorporates total cost care, clinical outcomes, access to timeliness of care, patient satisfaction, and loyalty. The care path improvement approach begins with the pre-define phase followed by define, measure, analyze, improve and control. This approach is for prioritizing and selecting the care pathways and addressing the greatest opportunities within them. The first phase toward implementation would be assessment and situational assessment. This phase involves providing infrastructure, resources, and direction for the program. It also involves providing framework for future evaluation of the program. This program needs to be supported by top management in...

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