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 quality care. In 2009, total health expenditures in the U.S. were $2.5 trillion. This means that $750 billion was the result of poor quality (Ralston & Park, 2011).
Care Management Model Based on My Philosophy
Case management and clinical pathways are strategies used to manage patient care. Although they use different approaches, both are related. The primary function of a case management program is to enhance the coordination of needed resources for patients and their families. Case managers facilitate access to services, both clinical and non-clinical, by connecting the individuals to resources that support him/her in playing an active role in the self-direction of his/her health care needs. Clinical pathways, on the other hand, are tools and systems. The tool reflects only part of the case management process. Ideally, the plan outlined on the pathway includes patient care interventions and outcomes (Spath, 1994). These pathways can be used as tools in order to achieve my philosophy of quality management that parallel that of Dr. Joseph Juran. As tools, pathways are used to organize and sequence specific elements of patient care to promote movement of the patient toward desired outcomes within an effective time frame (Spath, 1994). 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 order for it to be a success. Phase 2, the design phase, has four main objectives: (1) identification of the case types or populations for the pathways, (2) development of the content the pathways, (3) design of the documents and forms that support the program goals, and (4) development of education and evaluation of plans for use in program implementation. Phase 3 is pilot implementation: (1) to find ways of improving the pathway documents and forms to view toward ensuring maximal usage and usage, and (2) to ascertain that the variance data collected was meaningful. Phase 4, full implementation, is probably the most difficult part of the process because it involves extensive monitoring and education. This can be achieved over months or years and success is gradual and incremental. The two main objectives of this phase are: (1) to provide clinicians with a pathway to coordinate patient care and engage in collaborative practice while utilizing limited resources efficiently. (2) to collect useful and meaningful clinical documentation to guide care and determine trends and patterns that could be used to address quality improvement processes. Phase five is the final phase, evaluation and integration. The final phase involves evaluating the project to determine the achievement of pre-determined goals and objectives. Evaluation is both qualitative and quantitative. Qualitative involves determining the reasons and root causes of problems identified or successes achieved. Quantitative evaluation involves the use of data to determine if the objectives have been met (Cheah, 2000).
Conclusion
Clinical pathways and quality programs have many things in common. These strategies are based on the same principles of process selection: description, measurement, and re-engineering. Pathway implementation offers the health care organization the opportunity to integrate quality improvement around specific clinical functions rather than administrative processes. Pathways are not an end unto themselves, but a means of achieving a better understanding of the systems and processes used to help our patients get well. They can focus resources, provide a clear understanding for patients of what they should expect in their care, and provide a means of measuring patient's progress. They promote teamwork via increased understanding of roles on a multi-disciplinary team, and facilitate the use of guidelines in clinical practice in a usable format In order to achieve adequate implementation, serious consideration of potential barriers and specific locally agreed upon interventions to ensure effective implementation must be planned for and incorporated directly with the pathway. As with any quality improvement intervention, implementation and evaluation are a continuous process. This process needs to involve all those taking part in the protocol and following identification and dissemination. There must be decision support available, evaluation of the application, and incorporation of results into ongoing quality improvement. Successful implementation of care pathways is dependent on the development process. A lack of understanding about their role and use by any staff group will doom them to failure (Evans-Lacko, Jarrett, McCrone & Thornicroft, 2010).

References:
Cheah, J. (2000, June 9). Development of an implementation of a clinical pathway programme in an acute care general hospital in singapore. Retrieved from http://intqhc.oxfordjournals.org/content/12/5/403.full.pdf
Evans-Lacko, S., Jarrett, M., McCrone, P., & Thornicroft, G. (2010, June 28). Facilitators and barriers to implementing clinical care pathways. BMC Health Services Research, 10, 182. doi:10.1186/1472-6963-10-182
Ralston, E. & Park, A. (2011, July 11). An introduction to clinical care paths. The Big Q Blog. Retrieved from http://www.juran.com/blog/?p=280
Spath, P. (1994). Clinical paths: tools for outcome management. Ann Arbor, MI: The University of Michigan