title: Case management redesign in an urban facility.
abstract: OBJECTIVE
  To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges.
  
  
  METHODS
  Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities.
  
  
  METHODS
  Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff.
  
  
  RESULTS
  Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits.
  
  
  CONCLUSIONS
  Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.
authors.affiliation: Care and Outcomes Management Committee. Stefany@almadencare.com
authors.forename: Stefany
authors.initials: S
authors.lastname: Almaden
authors.forename: Brenda
authors.initials: B
authors.lastname: Freshman
authors.forename: Beverly
authors.initials: B
authors.lastname: Quaye
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D003152:Community Health Nursing / Q000458:organization & administration*; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007857:Leadership; D007902:Length of Stay; D015141:Los Angeles; D008507:Medically Underserved Area; D010351:Patient Discharge; D036301:Qualitative Research; D012947:Social Work / Q000458:organization & administration*; D014505:Urban Population