On case management systems

Editorials- On Case Management Systems Case Management is one of the popular phrases of the 1980s and 1990s. It is defined as a process of care coordination which promotes effective and efficient organization and utilization of medical and other resources. As Fields et al. state in their article on outcome of home care (pp. 310-317), the Case Manager functions as an individual to direct the complex process of homecare in technology-dependent children. The goal should be to achieve or maintain the maximum potential of the child, in the most appropriate and least restrictive environment. This may well be the home, but it may also be a rehabilitation facility or long-term care facility designed for these children. The interesting report by Fields and colleagues raises a number of questions regarding the use of the Case Management System. The authors make an excellent argument that in their region, they have improved homecare results of technology-dependent children by using an Independent Case Management System. Other systems may work best in other areas. Case Management can be the function of the discharging hospital, the third-party payor or of the receiving facility. Unfortunately, the phrase has also been usurped by some third-party payors as a guise for inappropriately decreasing the quality of services to technology-dependent children. Case Management should be family oriented, and some recommend it be community based. It may well function best when managed at the care center, where Case Managers most thoroughly familiar with the family and with the needs of the technology-dependent child can guide the individual family’s homecare management. The advantage of an independent organization is that as in the example of Fields et al., it may serve several institutions, none of which individually has the case load to make in-hospital case management appropriate. Technology-dependent children with respiratory dis- abilities are a new group of chronically ill children, for which the optimal care system has not yet been devised. From this perspective, it would seem best to look at these processes regionally and to establish case management systems that are best for the patients in a given institution, city, or region; the choice would depend on case volume and the competencies of the institution, governmental organizations, and healthcare services in the area. Case Management should always focus on providing for the child and family and only secondarily, though importantly, be a means for reducing costs. Each child, no matter how much assistance is needed, should be given the full opportunity to achieve the maximum that life has to offer. HOWARD EIGEN, MD Indiana University Medical Center James Whitcomb Riley Hospital for Children Indianapolis, Indiana 0 1991 Wiley-Liss, Inc.

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Transcript of On case management systems

Editorials-

On Case Management Systems

Case Management is one of the popular phrases of the 1980s and 1990s. It is defined as a process of care coordination which promotes effective and efficient organization and utilization of medical and other resources. As Fields et al. state in their article on outcome of home care (pp. 310-317), the Case Manager functions as an individual to direct the complex process of homecare in technology-dependent children. The goal should be to achieve or maintain the maximum potential of the child, in the most appropriate and least restrictive environment. This may well be the home, but it may also be a rehabilitation facility or long-term care facility designed for these children.

The interesting report by Fields and colleagues raises a number of questions regarding the use of the Case Management System. The authors make an excellent argument that in their region, they have improved homecare results of technology-dependent children by using an Independent Case Management System. Other systems may work best in other areas. Case Management can be the function of the discharging hospital, the third-party payor or of the receiving facility.

Unfortunately, the phrase has also been usurped by some third-party payors as a guise for inappropriately decreasing the quality of services to technology-dependent children.

Case Management should be family oriented, and some recommend it be community based. It may well

function best when managed at the care center, where Case Managers most thoroughly familiar with the family and with the needs of the technology-dependent child can guide the individual family’s homecare management. The advantage of an independent organization is that as in the example of Fields et al., it may serve several institutions, none of which individually has the case load to make in-hospital case management appropriate.

Technology-dependent children with respiratory dis- abilities are a new group of chronically ill children, for which the optimal care system has not yet been devised. From this perspective, it would seem best to look at these processes regionally and to establish case management systems that are best for the patients in a given institution, city, or region; the choice would depend on case volume and the competencies of the institution, governmental organizations, and healthcare services in the area.

Case Management should always focus on providing for the child and family and only secondarily, though importantly, be a means for reducing costs.

Each child, no matter how much assistance is needed, should be given the full opportunity to achieve the maximum that life has to offer.

HOWARD EIGEN, MD

Indiana University Medical Center James Whitcomb Riley Hospital for Children

Indianapolis, Indiana

0 1991 Wiley-Liss, Inc.