Case Management Advisor asked Catherine M. Mullahy, RN, CCM, president of Mullahy & Associates of Huntington, NY, and author of The Case Manager’s Handbook, Sixth Edition, published in June 2016, to discuss case management tools and strategies:
CMA: When you talk about essential patient assessment tools and tips, what are the most important ones that you describe?
Mullahy: While there are case management software programs that have patient assessment tools, they are often a series of checklists, boxes, and drop-down menus. These tools may be helpful, but for many busy case managers, their application tends to become a rote exercise; that is, another task to be completed, rather than something that could frame or guide the assessment process.
I strongly believe that the conversations case managers have with their patients are the most meaningful type of assessments. These interactions are where the most important information is gleaned. They also help establish rapport and trust, and convey that the case manager is genuinely concerned about the individual patient and his or her family. The exchange of information that occurs during this patient assessment conversation also provides the opportunity for the patient to express his or her own words about his or her perceptions of what the diagnosis, treatment plan, and prognosis is or might be and, equally important, what the impact of all of these aspects may have on his or her day-to-day life. In my opinion, it is one of the most effective ways to gauge whether a patient fully understands [his or her] medical condition and all that entails, as well as how it is being treated.
What’s most important is the discussion on how the case manager talks with the patient in the assessment process and the need to be proactive and supportive and to not make any assumptions, and to take the necessary time to lay a solid foundation.
CMA: What are some strategies and details case management leaders and staff can use for each of these assessment tools? For instance, if you had a tool that helped ensure regulatory compliance, what were the steps toward creating that tool and following it?
Mullahy: The tools we have developed over the years during which I had my case management company were, of course, mindful of legislation surrounding healthcare and case management. They were not, however, created to ensure compliance with those increasing regulatory issues, but rather to assess patient needs, identify problems, and develop a care plan that would enhance adherence to treatment and improve outcomes.
CMA: Do you have any case studies or examples of positive outcomes after the use of tools and tips?
Mullahy: We did develop assessment tools and questionnaires that our case managers utilized and which facilitated a more purposeful assessment of each patient. Samples are included in my book, The Case Manager’s Handbook, Sixth Edition.
These tools helped to guide the assessment process and ensure that we were able to capture all of the important elements, including clinical, medical, behavioral, socioeconomic, spiritual, vocational, financial, etc. As the assessment process evolved and the exchange of information between the patient/family and case manager occurred, problems were more easily identified. And the care plan was developed with short- and long-term goals established.
We certainly have case studies [in the book] that provide an overview of a patient’s situation.
CMA: Do you have samples of some of the tools that we could include?
Mullahy: Yes. In The Case Manager’s Handbook, Sixth Edition, a few assessment tools that we at Mullahy & Associates have created include “Initial Evaluation Guidelines” and “Initial Evaluation Worksheet.”
The “Initial Evaluation Guidelines” provide direction on the assessment process and its primary stages of meeting with the claimant/patient or family, contact with the patient’s primary attending physician, and contact with other key team members on the patient’s care team. Case managers learn about the main goals of these stages, which are to gather as much information as possible and to establish rapport with the patient, family members, physicians, and all team members.
The “Initial Evaluation Worksheet” is a thorough intake form that facilitates a comprehensive assessment. It contains sections for a case summary, patient profile (i.e., sex, race, age/date of birth, height, weight, physical appearance, sensorium, medical history, previous medical care such as surgical history, diagnoses, medications, outcomes, etc.), current medical status and treatment, and — when appropriate — a complete body system review.
The worksheet also has sections for entering information relating to the physician-case manager meeting/consultation; the physician plan of care; family composition/dynamics, including the family’s understanding of the patient’s illness and treatment plan, cultural and language notes, and home and community description; to vocational, motivational/behavioral, and financial. Case managers enter their summary and impression and recommendations.
CMA: Why does it work better for case managers to use the tools or follow the tips, rather than rely on their usual methods?
Mullahy: Unfortunately, the “usual” way is to rely on software programs and not consider the human factors, which are the patient’s voice and the value of patient exchanges. There is so much to be gained in the assessment process when [patients provide feedback] on what they understand their medical condition to be and how it is being treated. Based on their perceptions, a case manager often gains new insights into what the patient is experiencing and whether further communications and/or education are necessary for the patient and/or the patient’s family and whether adjustments to the treatment plan may be warranted.
It is often in the nuances conveyed in these patient exchanges that new and valuable insights can be gained, which put in motion essential measures that enhance the case management process.
CMA: Is there anything else you would like to say on this topic?
Mullahy: Technology has certainly advanced medical care and many administrative processes associated with the delivery of care. Commonly used assessment software programs have a place, but they should not be regarded as a substitute for direct case manager-to-patient/family communications, as related to the assessment process. These communications are a pillar to best-in-class case management across all stages of the process, including the assessment stage.