Vanderbilt N389: Health Care Management of Populations This is the text-only version of the syllabus. Note: All media (i.e., videos, audios, Flash presentations, PowerPoints, and their alternate versions) and learning activities (i.e., assigned readings, assignments, and discussions) are accessible only through the online course. INTRODUCTION This course addresses the skills and knowledge necessary for coordinating the care for individual patients, often referred to as case management, as well as managing the care of a population of patients, including the concept of disease management. The course begins with a thorough examination of within the walls case management origins, theoretical foundations, and competencies. We then look at between the walls case management the post acute continuum of care. The focus remains on individual patients, the various ways the case management programs are organized, and the various ways that the case manager role is enacted within different venues. During the second half of the course, we examine how clinical and financial risks are addressed for population groups. Health plans and disease management programs always work from a population perspective, as do many government programs. You will have the opportunity to analyze claims data in order to ascertain risk, and subsequently to develop an evidencebased disease management plan to address the risks that you identified from the data. DESCRIPTION This course addresses the skills and knowledge necessary for coordinating the care for individual patients, often referred to as case management, as well as managing the care of a population of patients, including the concept of disease management. The course begins with a thorough examination of within the walls case management origins, theoretical foundations, and competencies. We then look at between the walls case management the post acute continuum of care. The focus remains on individual patients, the various ways the case management programs are organized, and the various ways that the case manager role is enacted within different venues. 1
During the second half of the course, we examine how clinical and financial risks are addressed for population groups. Health plans and disease management programs always work from a population perspective, as do many government programs. You will have the opportunity to analyze claims data in order to ascertain risk, and subsequently to develop an evidencebased disease management plan to address the risks that you identified from the data. Level/Specialty: MSN (Health Systems Management) Pre- or Co-requisites: None Students are required to have fulfilled requirements for registration and documentation be on file in the Associate Dean for Academic Affairs office for the following: attendance at annual OSHA training program at the School of Nursing, proof of adequate health insurance, active Tennessee licensure if the student is a Registered Nurse; Current CPR certification for both adult and child; and required immunizations as listed in the Medical Center Catalog. (Students must have an active Tennessee license before beginning the final clinical practicum in the specialty component). Relationship to School's Philosophy, Goals, and Organizing Framework Nursing 389 incorporates the School of Nursing's belief that the central concepts of nursing practice are person, environment, health, and nursing. The orientation of this course is from the holistic, systems perspective with influences of health. Interventions are designed to enable people to increase control over, and to improve their health, their family's health, and the health of their aggregate or community. Credit: Three (3) credit hours. OBJECTIVES By the completion of this course, students will be able to: 1. Trace the history of case management from its origins in social work to the present. 2. Explore models of case management. 3. Describe the role of collaboration for advanced practice nurses in case management. 4. Understand the elements of a case management system. 2
5. Describe elements of population health care management. 6. Identify patterns and trends in population health using aggregate clinical databases for analysis. 7. Describe the essential elements of case management. 8. Construct a case management plan for a specific population. 9. Evaluate published research in case management. RESOURCES Recommended Learning Resources Mullahy, C. (2010). The Case Manager's Handbook, 4th edition. Sudbury, MA: Jones and Bartlett. ISBN 0-7637-3188-9 Textbooks can be purchased from the Vanderbilt University Bookstore http://www.shop-edmap.biz/van/. OUTLINE Dates Aug. 29 Sept. 4 Sept. 5 Sept. 18 Sept. 19 Sept. 25 Sept. 26 Oct. 9 Oct. 10 Oct. 23 Oct. 24 Oct. 30 Oct. 31 Nov. 6 Nov. 7 Nov. 13 Nov. 14 Nov. 20 Nov. 21 Nov. 27 Nov. 28 Dec. 4 Dec. 5 Dec. 11 Dec. 12 Dec. 18 Topic(s) Lesson One: The Case Manager Role and Environment of Practice Lesson Two: Origins of Case Management Lesson Three: A Day in the Life of A Hospital Case Manager Lesson Four: Barriers to Patient Adherence: Recognizing and Resolving Lesson Five: The Case Management Administrator Lesson Six: Insurance Providers and Health Benefits Plans Lesson Seven: Utilization Review Process Lesson Eight: Legal and Ethical Concerns Lesson Nine: Disease Management Thanksgiving Week Vacation Lesson Ten: Clinical Practice Guidelines Lesson Eleven: Population-Based Health Management Final Work GRADING SCALE For any graded learning activity i.e., assignments, discussions, etc., you will be assigned a grade out of 100 points rather than letter grade. Students 3
may earn up to 100% in the course. The Student must achieve a minimum grade of 70 to pass this course. The grading scale is as follows: GRADING POLICY Letter Percent Grade A+ 97-100 A 93-96 A- 90-92 B+ 87-89 B 83-86 B- 80-82 C+ 77-79 C 73-76 C- 70-72 F 69 or Below AD Audit Your final grade for this course will be derived from the following. Assignment Category Grade (%) Discussion 10% Exploration of the Literature Blog: - Blog Leadership - Blog Participation 15% 15% Case Management Observation/Departmental Analysis 10% Database Project 10% Disease Management Project 20% Case Vignettes 20% Total 100% Assignment Descriptions: Discussions The assignments and discussion questions are designed in such a way to reflect discussions we would be having if we were meeting face-to-face. Therefore, you will be graded according to your participation on the discussion boards and your timely completion of the assignments. A word of 4
caution: Do not get behind on the assignments. You will need the time at the end of the course. Exploration of the Literature Blog Login to the course to access guidelines for the Exploration of the Literature Blog.. Case Management Observation/Departmental Analysis Select one of the following two assignments and complete as directed: If you are not currently in a case manager role, arrange to spend a four hour block observing a nurse case manager in action this can be accomplished at your own hospital, or at a health plan. The framework for this observation experience and instructions for how to report your observations are linked below. Login to the course to access the framework for this observation experience and instructions for how to report your observation. If you are currently functioning in a hospital based case management role, you will complete a written analysis (page limit is four pages, excluding cover page and any references) of your department's structure and function. Include these (at least) elements: organizational chart depicting how the case management department relates to the overall organization, number and type of FTEs (e.g. 7.5 FTE social worker, 10 FTE case manager, 2.0 FTE clerical support, 1.0 department director, etc.), size and type of agency (e.g. 325 bed acute care hospital, 5 county Medicare home health agency, etc.), how case management services are organized, average size of case manager caseload, use of structured care methodologies (describe type and how used), educational preparation of case managers, educational preparation of social workers, description of key job functions of the case managers. Database Project Using a scrubbed patient database from a community clinic (furnished by course coordinator), select a subpopulation of patients at risk. Give rationale for why the patients in this cohort are similar; list the common risk factor(s). Using descriptive statistics, report the demographics of this subpopulation. If you were the health plan case manager, what risks would you be concerned 5
about and why? What would you want to address first? Submit your report in writing; 4 page maximum excluding reference and title page. Disease Management Project Using the previously identified a population-at-risk from the community clinic database, discuss the risk factors (in detail) and justify from the literature (bio-psychosocial) why this population should be actively case managed. Design a disease management model to meet the needs of this population. Cite references for evidenced based practice for this population (based on the diagnosis and natural course of disease). Describe exactly how the model addresses specific HEDIS requirements, if applicable. Submit this plan in writing; 8 page maximum excluding references and title page. If you develop or acquire patient education materials or structured care methodologies or other supplemental material, these may be scanned into your paper and will not count against the page limitation. Case Vignettes These are a series of case presentations that allow the student to synthesize much of the material presented in the course. Students must assimilate the patient or population situation, and answer key questions based on the theoretical foundations of population health management. A minimum of three vignettes will be presented. Response time is limited to two days per vignette. RULES AND REGULATIONS Attendance Policy This course takes place in a distance learning format. No physical attendance is required. Online participation is required. Policy on Late Work and Incompletes All required written work must be completed and handed in on the dates indicated. Late work, or resubmission of a paper or project must be negotiated with the course coordinator. For every day that an assignment is late, 3 points will be deducted from the grade, unless a late submission date has been negotiated with the course coordinator. The negotiation of a late submission date must occur prior to the date the work is originally due. Incomplete grades will be given only in very unusual circumstances at the discretion of the course coordinator and must be completed by the beginning of the following semester. 6
Coursework Policy Any paper submitted must be grammatically sound with evidence of proofreading before turning it in. Papers that do not meet these criteria will not be graded and will receive a 0%. Honor Code Policy All work in this course is based on the Honor Code of Vanderbilt University. Each student has the responsibility to obtain a copy of the Graduate/Professional Student Handbook and to read and understand the Honor Code and consequences of violation. Complaint/Grievance Process The faculty in the course welcome the opportunity to work closely with you to facilitate your learning and assist you in meeting the course objectives. If at any time you have concerns regarding an instructor or the course, discuss the problem with the instructor involved. If further discussion is needed, contact the course coordinator. If the problem persists, contact Linda Norman, Senior Associate Dean at 615-322-3804 or linda.norman@vanderbilt.edu. At the time of your discussion with the Senior Associate Dean, you should provide a written/emailed statement of the problem or grievance. If still unresolved, contact Dean Colleen Conway- Welch at 615-343-8876 or colleen.conway-welch@vanderbilt.edu for assistance. Disability Information Students who wish an accommodation for disability or health reasons are responsible for requesting accommodation from the appropriate faculty member. This self-identification is the only way to assure that the faculty can provide the appropriate accommodation. Anyone who has identified a need for an accommodation based on the impact of a disability should contact the coordinator to arrange an appointment as soon as possible. At the appointment you will discuss the course format, anticipate your needs, and explore potential accommodations. The Opportunity Development Center, located at Baker Building 110 21st Avenue South, will need to verify the need for accommodations and develop accommodation strategies. If you have not previously contacted the Opportunity Development Center, please call 615-322-4705. 7
Course and Faculty Evaluation It is the responsibility of the student to critique and evaluate the course and faculty, prior to submission of final grades. VUSN has a secure system to identify those students who have not yet completed the evaluation requirement, while maintaining the absolute confidentiality of the information submitted by the student. Faculty expect that all students will complete a course and faculty evaluation. Student feedback is used for continual improvement of courses. 8