What Case Managers Should Know About Their Roles and Functions

Tahan, Hussein M; Watson, Annette C.; Sminkey, Patrice V.

doi:10.1097/ncm.0000000000000115

Cited by 32 publications

(8 citation statements)

References 1 publication

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“…It is suggested to involve physical/ medical, behavioral/ cognitive and social determinants during the assessment, intervention and evaluation of case management process [31]. Case managers are required to equip themselves with knowledge related to concepts and strategies of case management, health care costs reimbursement, health care management and provision, concepts of rehabilitation and vocational, psychosocial systems and support [15], quality measurement, results evaluation as well as practice, legal and ethical standards [18]. Besides working along with patients, their families and hospital system, a case manager is also required to work holistically and efficiently, able to manage treatment plans in the most cost-effective manner and possess understanding that quality must not be compromised for financial purposes [32].…”

Section: Methodsmentioning

confidence: 99%

“…It is important to improve accountability and transparency in public health services and appreciate patient rights. The more patient-centered care, care coordination, care or case management and care transition strategies are emphasized, the more desired results are achieved [15]. However, clear legal arrangements for CM implementation in Indonesian hospitals is not yet available.…”

Section: Introductionmentioning

confidence: 99%

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Case Management for Equitable and Excellent Hospital Services

Muliarini¹,

Wiryani²,

Nasser³

et al. 2021

Proceedings of the 3rd International Conference on Indonesian Legal Studies, ICILS 2020, July 1st 2020, Semarang, Indonesia

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Patient-centered care as one of the health services quality domains can be implemented effectively and efficiently through the case management service model. The importance of case management is further enhanced by the presence of these factors: increased accountability and transparency in public health services, and the important role in respecting patient rights. However, implementation of case management in the hospital is not yet clearly regulated in existing legal products. The aim of this study was to find the legal basis for case management practice in health facilities within Indonesian laws and regulations. This research used a normative juridical approach. This study found that based on laws and regulations, the hospital organizes plenary individual health services, including preventive, curative, rehabilitative, also promotive in hospital. This service is able to achieve through a coordinated and collaborated continuum of care in the case management process. As mentioned in legislation, respect for patient rights realized through a collaborative partnership approach. This client-centered approach is responsive to the patient's needs, preferences, culture and values. Case management is a health service that upholds health service rights. Namely, participation, accountability, non-discrimination, transparency, upholding human dignity, empowerment and based on legal regulations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Management for Equitable and Excellent Hospital Services

Muliarini¹,

Wiryani²,

Nasser³

et al. 2021

Proceedings of the 3rd International Conference on Indonesian Legal Studies, ICILS 2020, July 1st 2020, Semarang, Indonesia

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“…The main concern in this segment is to focus on a provider and understand her coordination efforts. In general, many gaps exist in the care coordination literature, such as lack of interoperability, poor primary care management, lack of care coordination framework (Lanese et al., 2011a; 2011b; Ostovari & Yu, 2019; Tahan et al., 2015). Among these, we focus on poor primary care management that results in excessive ED visits.…”

Section: Single‐provider Perspectivementioning

confidence: 99%

Putting analytics into action in care coordination research: Emerging issues and potential solutions

Kumar

Qiu

Sen

et al. 2022

Production and Operations Management

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Care coordination involves shaping patient care activities and sharing information among all participants concerned with a patient's care to achieve safe and effective care. The objectives of care coordination are to promote sharing of patients' clinical information, keep patients and families informed, and manage effective referrals and care transitions. Failures in care coordination account for a large amount of waste per year in the United States. Many innovative healthcare organizations have recently recognized the danger of poorly coordinated care and have implemented analytics to improve it. Therefore, more analytics-based research (especially combining explanatory analytics with predictive analytics) is needed to direct efforts to improve care coordination. This paper focuses on systematically studying the extant literature to understand how analytics play a role in improving care coordination. Our goal is to identify a set of key research questions that would lead to new research areas in the use of analytics for care coordination. Based on these questions, we offer new analytics solution pathways to care coordination problems. K E Y W O R D Sbusiness analytics, care coordination, care transition, referral management … care coordination is not just a value proposition (higher quality, lower costs) but a patientsafety issue. Patients can be harmed when the many moving parts of their care are out of sync. We owe it to them to coordinate the care we provide and prevent this type of medical error.

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“…Peningkatan akuntabilitas dan transparansi dalam pelayanan kesehatan masyarakat serta pentingnya menghargai hak pasien, semakin menekankan pentingnya patient-centered care, continuum of care, manajemen perawatan/kasus, dan transisi perawatan sebagai strategi yang diperlukan untuk mencapai hasil yang diinginkan 15 . Namun demikian, pelaksanaan CM di RS masih belum mempunyai pengaturan yang jelas dalam aturan hukum yang telah ada.…”

Section: Latar Belakangunclassified

“…Proses CM juga harus memasukkan aspek fisik/medis, perilaku/kognitif, dan faktorfaktor penentu sosial dalam tahap penilaian, intervensi, dan proses evaluasi 31 . Case manager dituntut untuk membekali diri dengan pengetahuan terkait konsep dan strategi CM, manajemen dan pemberian perawatan kesehatan, reimbursement biaya perawatan kesehatan, konsep dan strategi rehabilitasi dan vokasi, sistem psikososial dan dukungan 15 , pengukuran kualitas dan evaluasi hasil, serta standar praktik, legal dan etis 20 . Seorang case manager, selain bekerja dengan pasien, keluarga, dan sistem, ia juga harus bekerja secara holistik dan efisien.…”

Section: Pembahasanunclassified

Case Management Untuk Pelayanan Rumah Sakit Yang Adil Dan Bermutu

Muliarini

Saputra²,

Sumarsono

2021

JHA

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Latar Belakang: Pelayanan berpusat pada pasien (patient-centered care) sebagai salah satu domain kualitas pelayanan kesehatan dapat dilaksanakan secara efektif dan efisien melalui model pelayanan case management (CM). Pelaksanaan CM secara profesional berfungsi sebagai sarana untuk mencapai kesejahteraan dan otonomi klien, meningkatkan pengalaman perawatan individu, meningkatkan kesehatan populasi, dan mengurangi biaya perawatan. Pentingnya akuntabilitas dan transparansi dalam pelayanan kesehatan masyarakat serta menghargai hak pasien semakin menekankan perlunya CM. Namun, pelaksanaan CM di rumah sakit (RS) masih belum mempunyai pengaturan yang jelas dalam produk hukum yang telah ada. Tujuan: Penelitian ini bertujuan untuk menemukan dasar hukum pelaksanaan CM di fasilitas kesehatan dalam peraturan perundang-undangan di Indonesia. Metode: Penelitian ini merupakan penelitian yuridis normatif, dengan pendekatan statute approach dan conceptual approach. Data yang digunakan adalah data sekunder yang terdiri dari bahan hukum primer, bahan hukum sekunder dan bahan hukum tersier yang berasal dari peraturan perundang-undangan yang berhubungan dengan tata kelola RS dan praktik kedokteran di Indonesia. Data dianalisis secara kualitatif dengan penarikan kesimpulan secara deduktif. Hasil: Dalam peraturan perundang-undangan, pelayanan kesehatan secara paripurna meliputi promotif, preventif, kuratif, dan rehabilitatif dapat dicapai melalui kesinambungan perawatan (continuum of care) secara terkoordinasi dan bersifat kolaboratif, seperti yang terdapat dalam proses CM. Penghargaan hak pasien yang disebutkan dalam peraturan perundangan dapat terwujud melalui pendekatan kemitraan kolaboratif yang berpusat pada klien dan responsif terhadap budaya, preferensi, kebutuhan, dan nilai-nilai yang diyakini pasien. Belum ditemukan sumber hukum terkait case manager dan CM sebagai subjek dan objek hukum di Indonesia. Kesimpulan: Case management dalam patient-centered care merupakan bentuk pelayanan kesehatan yang menjunjung tinggi hak pelayanan kesehatan seperti partisipasi, akuntabilitas, non-diskriminasi, transparansi, menjunjung martabat manusia, pemberdayaan, dan berdasarkan peraturan hukum. Pelaksanaan CM membutuhkan regulasi berupa peraturan perundang-undangan sebagai sumber hukum yang menaungi proses CM dan case manager di Indonesia.

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What Case Managers Should Know About Their Roles and Functions

Cited by 32 publications

References 1 publication

Case Management for Equitable and Excellent Hospital Services

Case Management for Equitable and Excellent Hospital Services

Putting analytics into action in care coordination research: Emerging issues and potential solutions

Case Management Untuk Pelayanan Rumah Sakit Yang Adil Dan Bermutu

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