Case management delivery models: the impact of indirect care givers on organizational outcomes.
OBJECTIVE
This study examined the effect of 2 case management delivery models on the organizational outcomes of length of stay (LOS) and payment denials.


BACKGROUND
Organizational leaders frequently identify case management as a method to manage LOS and demonstrate fiscal responsibility; yet, most case management research is anecdotal, describing specific patient populations or clinical units for outcome measurement.


METHODS
Regression analyses and analyses of variance were used to examine the role functions of case managers and the impact on LOS and payment denials. Outcomes were evaluated on medical, surgical, neurology, and cardiology populations across general, intermediate, and intensive levels of care.


RESULTS
Caseload distribution and role definition had a statistically significant impact on LOS and denial management across clinical specialty, units, and levels of care. The role of the case manager predicted 11% of the organizations LOS management.


CONCLUSIONS
Case management role definition impacts organizational success measures found in LOS reduction and improved reimbursement. Although only 11% of the LOS was predicted by the role function of care coordinators, altering a single RN role had a statistically significant impact on LOS across clinical specialties and levels of care, demonstrating that indirect care givers have an important impact on organizational success.
Thomas
Patricia
P
Clinical Nurse Leadership Program, University of Detroit Mercy, 4001 W. McNichols Road, College of Health Professions, Detroit, MI 48221, USA. thomaspl@udmercy.edu
D019090:Case Management; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay; D017146:Models, Organizational; D014600:Utilization Review