We Need a Standardized Vocabulary

Time has done a lot for many hospital services, but case management in particular, has seen dramatic changes to help the efficiency and effectiveness of clinical care. There are more educational and training programs, team member eligibility is more inclusive than ever before, and the focus on multiple aspects of progression of care is a rallying cry no matter how a hospital's program is organized.

It's 2017.  Beyond the large-scale, headline-grabbing events, there are the evolutionary daily, hourly, moment-to-moment adjustments that occur as the marketplace shifts, technologies get updated or launched, and research uncovers new findings. When the marketplace changes, hospitals change. Right?  Yet many organizations get stuck in the status quo as the landscape changes around them. Hospitals across the country keep doing the same things in the same ways they’ve done them for years. This is especially true when it comes to case management.  Hospital leaders look at their past activities, may make a few tweaks and adjustments based on their internal budget numbers, staff bandwidth, and the like, and plow forward.  And when they don’t get results, they get incredibly frustrated.

Times change and case management has evolved and with it.  For those of you looking forward, consider these evolutionary trends that we've encountered.  

As originally developed by Karen Zander at NEMC, case management in the hospital described a new nursing practice model where the admitting nurse followed patients throughout their acute episode of care to keep the care team current about the patients' progress. The goal at the time was to reduce length of stay by proactively communicating up-to-date information with members of the patients' care team as the patient moved from one unit to another. 

With changes in the marketplace, the term case management has come to describe, what ACMA calls a "compilation of hospital services."  Often depending on the size of the hospital, those services may include a host of service lines such as utilization review, care coordination,  social services, transitional care, and others.  But the trend is pretty clear when one peruses the literature....case management has become the generic term encompassing a host of mission-related activities. 

Care coordination is also known as care management, coordination of care, progression of care, care navigation, and other designations which all seem to describe a deliberate, longitudinal process to advocate, communicate, and collaborate with the patient's care team to improve outcomes;  or, more specifically, to achieve the Triple Aim:  Improve the quality of care, the costs of care and the patient's experience of care.  As written before in this column, the cost of care coordination is substantial and is therefore being reserved for a selected population of high risk patients.  

Transitions of care is popularly used in place of discharge planning.  It was once described as better terminology reflecting the fact that there are many patients who may never be actually 'discharged' from a healthcare system but may instead 'transition' from one level of care within the system to another level of care as part of a care coordination model.  Nevertheless, it appears that the term 'discharge planning' is still being used in nursing circles to describe a core compenetnfcy of professional nursing practice.

Transitional care, on the other hand, has morphed into a formal post acute model of care which serves as a 'half-way house' between the rigors of acute care and the routines of self-care at home.  There are now residential Transitional Care Centers, ambulatory clinics, and on- campus hotels where patients [occasionally with their families] receive assertive rehab from the effects of hospitalization and/or a surgical procedure. These TC programs are meant to strengthen the patient's functional status, provide focused medication education and reinforcement of instructions, expand healthcare literacy, and address social issues that may impact the patient's ability for self-care. For organizations with at-risk contracts, the TC model is a key piece in the coordination of care process.

As the healthcare environment continues to change, new channels of case management opporutnities will inevitably open for expanded services. We believe case management leaders and their executive sponsors must set the stage today to succeed tomorrow.