Understanding DM helps case managers do their job

Complementary practices combine for better care

By Diane L. Huber, PhD, RN, FAAN, CNAA, BC
Immediate Past Chair
Commission for Case Manager Certification (CCMC)
Rolling Meadows, IL

The term "disease management" has grown in popularity and widespread usage over the past decade to the point that it is assumed most case managers and related professionals know exactly what this term means. Although case managers may believe that they understand at least the basics of disease management, it is important to step back and carefully consider its definition and protocols.

Disease management has evolved since the mid-1990s, becoming more sophisticated and statistically rooted, with tracking mechanisms to measure approaches and outcomes. Similarly, the field of case management also continues to change as it is practiced in a wider variety of venues.

Given the dynamics of the two fields, case managers would benefit from a good working knowledge of disease management. Especially important is the use of evidence-based practice for the treatment of specific diseases.

Looking at the term literally, disease management would appear to mean the management of diseases (just as case management seems to refer to the management of cases). However, this is far too simplistic and limited a view. For one thing, seeing disease management only from the perspective of the disease would put it primarily in the domain of physician practice. The Disease Management Association of America (DMAA) sees disease management as multidisciplinary, although medical care is a central component.

Moreover, disease management focuses on individuals or groups of people who are affected by specific health issues. These include chronic diseases such as diabetes, cardiovascular disease and hypertension; medical conditions such as obesity or high-risk pregnancies, and behavioral issues such as depression. As the DMAA states, "Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant."

What then are the implications of disease management on case management? The case manager’s primary responsibilities are to act as an advocate for the patient and/or family and to provide access to the right care and treatment resources at the right time in a cost-effective and efficient manner.

As the Case Management Society of America (CMSA) defines the practice, "Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes."

Clearly, case management and disease management are complementary. Case management focuses on the needs of the individual, and disease management emphasizes the treatment and prevention of specific diseases that affect an individual or particular population. Effective programs will blend the two practices, building on the strengths of each. Additionally, case managers can draw upon the tools and techniques of disease management to enhance their ability to advocate for patients and allocate appropriate care and treatment resources.

Among the sophisticated processes that have emerged in the field of disease management is evidence-based practice, which draws upon the current best evidence from systematic research in clinical practice. This research-based evidence then is used in conjunction with clinical judgment in the assessment and management of individual cases. As case managers work with patients who may have one or more chronic conditions — particularly in light of the aging population — it is essential to become knowledgeable about evidence-based practice.

Fortunately, there are resources readily available for case managers to access reliable and accurate information about evidence-based practice related to specific diseases. The Agency for Healthcare Research and Quality (www.ahrq.gov), for example, provides access on-line to information and evidence-based practice protocols in a variety of clinical categories, including cancer and blood disorders, heart and vascular diseases, musculoskeletal disorders, and pediatric conditions.

By accessing this information, case managers can avail themselves of the latest accepted best practices in the field and fulfill continuing education goals. For certified case managers (CCMs), becoming educated in best practices also will enhance their knowledge, experience, and distinction. The CCMC, which is the first and largest nationally accredited organization to certify case managers, requires CCMs to commit to continuing education in order to maintain their certification.

Greater understanding of disease management will complement the knowledge and experience of case managers today. Using the evidence-based approach emphasized in disease management, case managers can better educate patients and their families about the diseases and health conditions they face and the self-care options available to them.

[Editor’s note: Diane Huber, PhD, RN, FAAN, CNAA, BC, is the immediate past chair of the CCMC. She also is a professor at the University of Iowa (UI) College of Nursing, teaching case management courses, an investigator at the UI Center for Addictions Research, Institute for Strengthening Communities, and has a secondary appointment at the UI College of Public Health Department of Health Management and Policy. She also is the author/editor of Disease Management: A Guide for Case Managers (February 2005, Elsevier).

The CCMC is the first and largest certifying body for case management professionals to be accredited by the National Commission for Certifying Agencies. URAC also has determined that the CCM credential is a recognized case management certification. For more information, contact the Commission for Case Manager Certification at (847) 818-0292 or visit the CCMC web site at www.ccmcertification.org.]