Final Paper

Sample Answer

In the past years, chronic illnesses have become a prominent part of the most common conditions among populations leading to millions of deaths annually. Indeed, chronic illnesses are among the world’s top seven causes of death. Apart from the high number of death cases, chronic illnesses result in numerous negative impacts, such as increased unplanned admissions and emergency visits (Joo & Huber, 2019). Therefore, there have been past and present efforts to better manage these chronic conditions for better patient outcomes.

Such strategies have been used to target patients with chronic diseases who frequently use emergency departments or have frequent inpatient admissions. One of such approaches is the use of case management programs to help reduce hospital admissions, emergency visits, and reduced length of stay. Therefore, the purpose of this assignment is to write a proposal for the use of a case management program among adult patients with chronic conditions.

Problem Statement

Data from the World Health Organization indicates that thirty-eight million people globally die of chronic diseases. Besides, these conditions are among the first seven of the top ten causes of mortality throughout the world (Di Mauro et al., 2019). In addition, chronic illnesses are known to cause enhanced rates of unplanned hospitalization and emergency department use. Therefore, it is key to utilize strategies that can help in better management, such as case management programs. Case management programs can lead to expected activities such as safe discharge and support services hence decreasing the costs connected to chronic illnesses.

Organizational Culture and Readiness

Organizational culture is one of the factors that impact the direction in which change efforts take in an organization (Mannion & Davies, 2018). Therefore, a culture capable of supporting organizational change and successful implementation of evidence-based practice is key. Therefore, this section explores the organizational culture and its relationship with change. The targeted organization is majorly hierarchical, where the final decisions are left in the hands of the management. Elements of clan and adhocracy cultures dominate routine practice and relationships. Such elements include people-centered decisions, a collaborative work environment, horizontal communication, and supporting innovation.

The organization’s staff is usually informed regarding practice change and organizational development, while the leadership also supports employee engagement and support innovative efforts. Therefore, from such a view, the organization’s culture supports change. Readiness for change was assessed using the Organizational Readiness to Change Assessment (ORCA) tool. This tool major on three main aspects of change, including change-facilitation, the environmental context, and the strength of the evidence recommending the change (Kononowech et al., 2021). From the survey results located in the appendix, the proposed change has the backing of solid evidence from randomized controlled trials.

The leaders are also supportive of innovation, and there are also sufficient resources and staff to help successfully drive the project to completion. It is vital to improving cost-effectiveness, safety, and quality. As such, the facility can apply employee-centered and organization-wide approaches such as incorporating technological change and telehealth to help lower healthcare spending (Schneider, 2018). Employee performance appraisal can also be used in the identification of the skill gaps and arranging for training and development strategies to help build their capacity, improve their output and improve quality. Readiness assessment, engagement in active communication, and employee training can be key in facilitating readiness for change.

Three main stakeholders have been identified to help create a conducive environment that supports incremental change. They include nurses, the organization’s leaders, and the patients. While the leaders support the financial needs of the project, nurses engage in the implementation process while patients will be expected to embrace the case management and participate in care coordination as needed. Various technological applications will also be used to enhance the success of the project. They include communication devices, risk assessment tools, and screening gargets.

Literature Review

A literature review was conducted to obtain current evidence on case management. Therefore, a database search was carried out using relevant search terms. In one of the articles, Kim and Lee (2020) conducted research to determine the impact of case management on health care utilization. Using a total of 1741 research subjects, the researchers found that using case management led to reduced healthcare costs and care and better self-care ability. Another research was conducted by McCants et al. (2019). In a descriptive retrospective study, they compared the impact of usual care treatment and case management among patients with heart failure and diabetes.

Analysis of the data showed that the use of case management substantially lowered the rates of readmissions among these patients. In yet another study, Grover et al. (2018) explored the relationship between case management at the emergency department and the length of hospital stay. The data for patients enrolled in the study was collected before and after the intervention. This study revealed that the patients enrolled in the case management program reported a reduction in length of stay by one hundred and seventy-eight days, inpatient admission by 39%, and emergency visits by 49%. Hudon et al. (2018) also carried out a study using a case management program known as VISAGES on patients with chronic illnesses and who need complex care. In a randomized controlled trial, the participants were divided into intervention and control groups.

Analysis of the results showed that the use of case management was more impactful in reducing psychological distress among the patients. Lower levels of distress were connected to better recovery and reduced incidences of hospital readmissions with chronic conditions. More recently, Mattei da Silva et al. (2020) explored the impact of applying nursing case management in controlling blood pressure among patients. In a randomized controlled trial, the participants were divided into control and intervention groups, with each group having forty-seven participants. A comparison of the data collected at baseline and at six and twelve months of follow-up showed that the intervention group had a better decrease in blood pressure, which further underlines the importance of using case management in managing patients with chronic conditions.

In another research, Uittenbroek et al. (2018) studied the experiences of health care professionals such as nurses and social workers with case management. The researchers collected data through the in-depth interview, which they then analyzed through qualitative content analysis. One of the most important findings is that with the use of case management, the nurses were capable of focusing more on the patient’s health conditions. In addition, the social workers also dealt with the patients’ psychosocial problems better. Recently, La Regina et al. (2020) studied the impacts of case management on health outcomes among patients living with type 2 diabetes. This study involved forty participants, and an electronic form was used to collect data on care plans and medication adherence. The analyzed data showed that case management led to reduced waiting times as well as improvement in patients’ individual care plans and medication adherence.

Wong et al. (2021) also conducted research on using telecare case management programs during the Covid-19 pandemic while focusing on adults discharged from the hospital. They used a randomized controlled trial where sixty-eight participants were recruited. Data were collected at baseline and after three months. When the data was analyzed, the telecare group using case management displayed better life quality and medication adherence in comparison to the usual care group. Therefore, this research also shows the importance and effectiveness of case management when it comes to the improvement of health outcomes among patients with chronic illnesses.

The Change Model

Change models are key in guiding quality improvement or change projects. The selected model to be used in guiding this project is the Iowa model. This model has widely been applied in the healthcare practice during the change to help in addressing the patients’ priority concerns (Duff et al., 2020). The central pillars of this model include monitoring of healthcare costs, enhanced nursing practice, and improvement of patient outcomes as guided by scientific evidence. The current project entails using case management to manage chronic illness among patients who visit the emergency department. Therefore, the Iowa model will be key in ensuring that the implemented solution is supported by evidence and can help in achieving the desired outcomes.

This model has eight major steps applied in the integration of evidence-based practice. In the first step, the trigger needed to bring change is identifying. In the second phase, the EBP leaders determine whether the problem is a priority depending on the impacts on practitioners’ health, health process, and patient care, among other things. In the next stage, a team that can help in EBP change evaluation and implementation is formulated, followed by appropriate gathering and analysis of appropriate data to help lead the change. The fifth step entails critiquing and synthesizing research from the best level of evidence with a major focus on evaluating whether the proposed change is scientifically feasible (Cullen et al., 2022).

In the sixth step, a decision is made on whether the available research is adequate to support the implementation of a practice change, followed by an initiation of a pilot program and finally, the evaluation of results and the introduction of the new changes into practices. The stages of the Iowa model will be key in implementing the proposed project, with the first stage entailing the identification of the trigger. The current problem-focused trigger is chronic illnesses among patients visiting the emergency department and the associated adverse outcomes. In the second phase entailing the determination of priority level (Cullen et al., 2022), it has been noted that chronic disease requires immediate attention as the disease increases the spending of hospital resources due to frequent emergency department visits and unplanned admission.

This project will involve interprofessional team members, including nurses, departmental leaders, and the management, which will focus on developing, evaluating, and implementing the change. The evidence is to be sourced from scholarly literature which has been recently published and support the use of case management in managing chronic condition (Cullen et al., 2022). In addition, such evidence will be synthesized and critiqued in an effort to determine whether the presented research is sufficient enough to help in implementing case management. Eventually, a pilot program is to be initiated to find out the possible impact of the proposed case management before integrating it into the full practice.

Implementation Plan

Evidence-based practice project implementation is one of the critical phases. However, this phase can be challenging due to various factors such as the project’s sustainability, time constraints, inadequate resources, and the stakeholders involved (DeNisco. 2019). Therefore, it is important to formulate a structured implementation plan to enhance the success chances of the evidence-based project. As such, this section explored various aspects of the implementation plan with the hope that the project will be key in reducing the rates of readmissions, emergency visits, and length of hospital stay among patients with chronic diseases.

The Setting and Access to Research Subjects

As part of the plan, the proposed project will take place in a hospital facility handling patients with chronic illnesses such as renal disease, hypertension, and diabetes. The facility has a nursing unit with a 300-bed capacity and also handles patients with comorbidities. The nurses and physicians will be involved and will receive case management training for both the outpatients and inpatients. The study subjects will be patients admitted to the unit and those visiting the emergency department. Consent will also be obtained from the study subjects that they have wilfully agreed to part of the study. It is worth noting that participation in the research will completely be voluntary; hence the participants will sign the consent forms as an indication that they have obtained enough information regarding the project and that they are willfully participating in the project.

Timelines

It is important to allocate sufficient time to enable the effective implementation of the project. The proposed Iowa model has eight main steps, implying that sufficient time is required for implementation. As such, the proposed timeline for the project is six to twelve months. The proposed timeline will be sufficient for getting institutional approval, data collection, implementation, and evaluation of the findings.

The Budget and Resources

The success of an evidence-based project heavily hinges on the availability of resources and the correct allocation of the same. The implication is that an appropriate budget and a list of the required resources should be formulated. The formulated budget is expected to cover various aspects of the project. The detailed budget and resource list have been included in the appendix section.

The Project Design and Data Collection Tools

This project is intended to use a non-experimental mixed method that brings together quantitative and qualitative approaches to enable a better and in-depth research process and analysis of data (Melnyk & Fineout-Overholt, 2019). Interviews and surveys will both be implemented in data collection. The mixed method of data collection ensures a sequential approach to data collection at different points of the implementation process.

Monitoring Methods and Instruments

Monitoring is an important part of the project. Therefore, surveys and questionnaire will be applied in carrying out the initial baseline assessment to help explore the existing policies and practices that impacts care offered to patients with a chronic condition. The surveys and questionnaires will also be key in understanding the efficacy of implementing case management in chronic disease management (Melnyk & Fineout-Overholt, 2019). It is vital to note that the data obtained will be analyzed by using relevant statistical tools to help give interpretable results.

Evaluation Plan

Evaluation is key in the evidence-based practice process as it allows one to find out if the expected outcomes and set goals have been met. The project has been designed with the major aim of increasing care accessibility, quality of life, and improving patient safety among patients with chronic conditions. Therefore, various outcomes were targeted. One of the outcomes is reduced rates of hospital readmissions in the hospital. Other outcomes include a lower rate of emergency room visits and reducing the length of hospital stay (Hudon et al., 2018).

In addition, it is expected that the intervention will be key in improving the quality of care and reducing the costs of managing patients with chronic conditions. Upon the collection of data, statistical tests will be key during analysis. The statistical tests will also be important in the evaluation of the hypothesis. Again, the tests will also be used in examining outcome variables and predictable variables as well as computing the variance (Halcomb, 2019). Again, the implementation of case management among the patient will use regression to help display the cause-effect outlook.

Regression has been chosen since it is the most potent tool as it can effectively help show the difference between the period before the intervention and after the intervention. Outcome measures and evaluation are also key. Therefore, analysis of the collected data and the evaluation processes will help show the impact of the intervention on the facility, nurse practitioners, and the targeted patient population. Questionnaires and surveys will be used to generate feedback from the participants with the focus on formulating necessary measures (Melnyk & Fineout-Overholt, 2019).

Therefore, there are enhanced chances of patients developing better self-management hence shorter hospital stays and reduction of hospital visits. As earlier indicated, the focus of this project was to improve chronic disease management among patients through a nurse-led case management strategy. Therefore, the predicted outcomes include lower incidences of emergency room visits, lower readmission cases, and reduced length of hospital stay. In the case where the outcomes do not lead to the expected results, then a review of the project’s components will be done with the focus on taking corrective measures (Melnyk & Fineout-Overholt, 2019).

There are also plans to maintain, extend, revise or discontinue the proposed intervention. If the project achieves its goals, then it will be continued. In such a case, the project shall have yielded positive outcomes and resulted in benefits for the stakeholder. The implication is that the intervention will be integrated into the organizational culture as part of best practice.

Therefore, the case management solution will be implemented in other hospital units too. Informed by the cost-benefit analysis, the project will have to be discontinued if it is not sustainable. The decision to discontinue the project will require that the input of every stakeholder is sought. Such a step will be key in avoiding time and resource wastage (Melnyk & Fineout-Overholt, 2019). In addition, as part of the discontinuing plan, necessary corrective measures should be laid down to help in either improving the current approach or helping the organization to successfully revert to the previously existing approach which was used in managing the patients with chronic conditions.

Conclusion

Chronic conditions have been shown to result in various adverse outcomes among patients. As such, it should be a central focus of nursing care. The implication is that there should be effective nursing interventions that can be applied to ensure that these patients have better outcomes. As such, this project is proposing to explore the use of case management in an effort to help improve outcomes connected to chronic illnesses.

Some of the targeted outcomes include reduced hospital stay and lower incidences of emergency room visits. A comprehensive literature review has been performed to find out the current status of case management use in the management of chronic diseases. Besides, other aspects of the project have also been explored, including the organizational culture and its readiness for change, change model, implementation plan, and evaluation plan.

References

• Di Mauro, R., Di Silvio, V., Bosco, P., Laquintana, D., & Galazzi, A. (2019). Case management programs in emergency department to reduce frequent user visits a systematic review. Acta bio-medica Atenei Parmensis, 90(6-S), 34–40. https //doi.org/10.23750/abm.v90i6-S.8390
• Grover, C. A., Sughair, J., Stoopes, S., Guillen, F., Tellez, L., Wilson, T. M., Gaccione, C., & Close, R. (2018). Case management reduces length of stay, charges, and testing in emergency department frequent users. The Western Journal of Emergency Medicine, 19(2), 238–244. https //doi.org/10.5811/westjem.2017.9.34710
• Hudon, C., Chouinard, M. C., Dubois, M. F., Roberge, P., Loignon, C., Tchouaket, É., … & Bouliane, D. (2018). Case management in primary care for frequent users of health care services A mixed-methods study. The Annals of Family Medicine, 16(3), 232-239. https //doi.org/10.1370/afm.2233
• Joo, J. Y., & Huber, D. L. (2019). Case Management Effectiveness on Health Care Utilization Outcomes A Systematic Review of Reviews. Western journal of nursing research, 41(1), 111–133. https //doi.org/10.1177/0193945918762135
• Kim, M. J., & Lee, E. (2020). How to reduce excessive use of the health care service in Medical Aid beneficiaries Effectiveness of community-based case management. International Journal of Environmental Research and Public Health, 17(7), 2503. http //dx.doi.org/10.3390/ijerph17072503
• La Regina, R., Pandolfi, D., Stabile, N., Beloni, L., Glisenti, F., Griggio, P., … & La Regina, G. (2020). A new case manager for diabetic patients A pilot observational study of the role of community pharmacists and pharmacy services in the case management of diabetic patients. Pharmacy, 8(4), 193. https //doi.org/10.3390/pharmacy8040193.
• Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality improvement. Bmj, 363. https //doi.org/10.1136/bmj.k4907
• Marcotte, L. M., & Liao, J. M. (2020). What we talk about when we talk about care management. The American journal of managed care, 26(6), 245–247. https //doi.org/10.37765/ajmc.2020.43486
• Mattei da Silva, A. T., de Fátima Mantovani, M., Castanho Moreira, R., Perez Arthur, J., & Molina de Souza, R. (2020). Nursing case management for people with hypertension in primary health care A randomized controlled trial. Research in Nursing & Health, 43(1), 68-78. https //doi.org/10.1002/nur.21994
• McCants, K. M., Reid, K. B., Williams, I., Miller, D. E., Rubin, R., & Dutton, S. (2019). The impact of case management on reducing readmission for patients diagnosed with heart failure and diabetes. Professional Case Management, 24(4), 177-193. DOI 10.1097/NCM.0000000000000359
• Uittenbroek, R. J., van der Mei, S. F., Slotman, K., Reijneveld, S. A., & Wynia, K. (2018). Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model A qualitative study on embrace. PloS One, 13(11), e0207109. https //doi.org/10.1371/journal.pone.0207109
• Wong, A. K. C., Wong, F. K. Y., Chow, K. K. S., Wong, S. M., & Lee, P. H. (2021). Effect of a telecare case management program for older adults who are homebound during the COVID-19 pandemic A pilot randomized clinical trial. JAMA Network Open, 4(9), e2123453-e2123453. doi 10.1001/jamanetworkopen.2021.23453