SIM 440 Collaboration for Improving Outcomes Assignments

SIM 440 Collaboration for Improving Outcomes Assignments
SIM 440 Collaboration for Improving Outcomes Assignments
Activity 1 Case Management Implementation Plan
Create a plan to implement case management at your workplace. What is your recommended plan for the use of case managers in your organization for patients with your chosen chronic illness? Identify people within your organization who are stakeholders or would support your plan. Whose support do you need to get your plan implemented? Identify your goals – what do you hope to accomplish with your case management plan? SIM 440 Collaboration for Improving Outcomes Assignments

Often, starting with our goals helps – it’s a backwards design. As we think about a case management plan we are proposing for our workplace, what do we want to accomplish? Remember – goals should be measurable. For example, if the chosen chronic disease is diabetes, one goal may be:

Clients will have decreased incidences of hyperglycemia requiring hospitalization

Once we determine what we want to accomplish, we can begin to construct our plan to achieve the goal. To achieve this goal, our plan may include providing education in a manner the client can understand (being sensitive to cultural needs), access to phone support, or inputting glucose readings into their electronic health record for documentation the case manager can evaluate and use to reach out to the client.
To put this plan in action, whose support would we need? Primary Care Physicians, Utilization Review personnel, and the Chief Financial Officer would all have an interest in optimizing patient health and reducing costs.
Reading and Resources
Read Ferrier, G. D., & Trivitt, J. S. (2013). Incorporating quality into the measurement of hospital efficiency: A double DEA approach. Journal of Productivity Analysis, 40(3), 337-355. https://search.proquest.com/docview/1448800469?accountid=169658
Search the site for US Department of Health and Human Services “Hospital Compare” and use the interactive database to compare and contrast health plans, hospitals, etc. How might you use this site with patients as a case manager?
Additional Instructions:

All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes – Case Management Implementation Plan

Description: The baccalaureate graduate nurse will demonstrate teambuilding and collaborative strategies when working with interprofessional teams to deliver evidence-based, patient-centered care.

Course Competency: 4) Coordinate the care of individuals across the lifespan utilizing principles and knowledge of interdisciplinary models of care delivery and case management.

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential VI

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Implementation plan.
Constructs an implementation plan.
Explains an implementation plan.
Lists elements of an
implementation plan.
Does not provide an
implementation plan.

Gain Buy-in
Proposes approach to gain buy-in from key stakeholders. SIM 440 Collaboration for Improving Outcomes Assignments
Indicates an approach to gain buy-in from key stakeholders.
States an approach to gain buy-in from key stakeholders.
Does not discuss an approach to gain buy-in from key stakeholders.

Key Outcomes
Examines key outcomes of the case management
plan.
Identifies key outcomes of the case management
plan.
Lists key outcomes of the case management
plan.
Does not discuss key outcomes of the case management
plan.

APA, Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation.
One to three errors in APA, Spelling, and Punctuation.
Four to six errors in APA, Spelling, and Punctuation.
Seven or more errors in APA, Spelling, and Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

SIM 440 Collaboration for Improving Outcomes Assignments Activity 2 Chronic Disease Management
Choose one of the following chronic diseases to address in this component:

Hypertension
Chronic Obstructive Pulmonary Disease
Diabetes Mellitus type 2
Childhood Asthma

Complete the following:

Detail the population including who the members are, contributing causes, past medical history, family/genetic components.
Evaluate the population including size, seriousness of disease, special needs, etc.
Assess the need for formal case management.
Argue the potential benefits to implementing a case management model including economics, quality of life/care, social disruption, etc.
Analyze why nursing should be a part of this plan. What can they bring to the table?
Identify other team members who should be included on a case management team. Why should they be on this team and what is their role?

Reading and Resources
Chapter 2 pages 44-47 in Fundamentals of Case Management Practice
De Regge, M., Pourcq, K. D., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: A systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research, 17
Davis, M. M., Devoe, M., Kansagara, D., Nicolaidis, C., & Englander, H. (2012). “Did I do as best as the system would let me?” healthcare professional views on hospital to home care transitions. Journal of General Internal Medicine, 27(12), 1649-56.
Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

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Rubric

Collaboration for Improving Outcomes – Chronic Disease Management

Description: The baccalaureate graduate nurse will collaborate with other members of the healthcare team to improve patient outcomes.

Course Competencies: 1) Assess the roles of the nurse case manager in the contemporary health care structure. 2) Develop a holistic case management plan for a specified disease or population that incorporates the role of insurance, health care finance, and utilization of community resources. SIM 440 Collaboration for Improving Outcomes Assignments

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential III

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Population
Detail the population
Identifies the population
List the population
Does not address section

Evaluate
Evaluates the population (size, seriousness, special needs, etc.)
Reviews the population (size, seriousness, special needs, etc.).
Names the population (size, seriousness, special needs, etc.).
Does not address section

Assesses
Assesses why there should be a formal case management program.
Explains why there should be a formal case management program.
Lists why there should be a formal case management program.
Does not address section

Potential benefits
Argues the potential benefits to implementing a systematic case management plan (economics, quality of life/care, social disruption, etc.).
Classifies the potential benefits to implementing a systematic case management plan (economics, quality of life/care, social disruption, etc.).
Lists the potential benefits to implementing a systematic case management plan (economics, quality of life/care, social disruption, etc.)
Does not address section

Analyze
Analyzes why nursing should coordinate this
plan of care.
Discusses why nursing should coordinate this
plan of care.
Lists why nursing should coordinate this plan of care.
Does not address section

Identify
Identifies the other team members who should be included and why.
Recognizes the other team members who should be included and why.
Lists the other team members who should be included and why.
Does not address section

APA,
Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation.
One to three errors in APA,
Spelling, and Punctuation.
Four to six errors in APA, Spelling, and Punctuation.
Seven or more errors in APA,
Spelling, and Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

Activity 3 Continuum of Care
Explain how the concept continuum of care is used in case management and within your organization. What new services/programs are your organization currently evaluating or performing that are assisting patients to reach their health goals? How do these services/programs impact the bottom line of the organization?
Quality indicators, such as accessibility, appropriateness, continuity, effectiveness, efficacy, efficiency, timeliness, patient perspective issues, and safety, can influence quality of care. Choose one indicator and discuss its influence on care inventory environments, including local, state, national, and global. Discuss the practice of linking hospital reimbursement to performance outcomes.
Reading & Resources

Chapter 2 pages 44-47 in Fundamentals of Case Management Practice
De Regge, M., Pourcq, K. D., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: A systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research, 17
Davis, M. M., Devoe, M., Kansagara, D., Nicolaidis, C., & Englander, H. (2012). “Did I do as best as the system would let me?” healthcare professional views on hospital to home care transitions. Journal of General Internal Medicine, 27(12), 1649-56.
Asgar, A. H., Ravaghi, H., Kringos, D. S., Ogbu, U. C., Fischer, C., Azami, S. R., & Klazinga, N. S. (2014). Using quality measures for quality improvement: The perspective of hospital staff. PLoS One, 9(1)
Buerhaus, P. I., DesRoches, C., Applebaum, S., Hess, R., Norman, L. D., & Donelan, K. (2012). Are nurses ready for health care reform? A decade of survey research. Nursing Economics, 30(6), 318-29, quiz 330.
Elwood, T. W., DrP.H. (2013). Health reform in the context of entelechy. Journal of Allied Health, 42(3), 127-34.
Feemster, L. C., & Au, D. H. (2014). Penalizing hospitals for chronic obstructive pulmonary disease readmissions. American Journal of Respiratory and Critical Care Medicine, 189(6), 634-9.
Review American Association of Managed Care Nurses to explore information related to finance and payment structuring.

Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes – Continuum of Care

Description: The baccalaureate graduate nurse will apply concepts of quality and safety to identify clinical questions and describe the process of changing current practice.

Course Competencies: 2) Develop a holistic case management plan for a specified disease or population that incorporates the role of insurance, health care finance, and utilization of community resources. 3) Examine the role of case management in end of life care including ethical and legal issues. 4) Coordinate the care of individuals across the lifespan utilizing principles and knowledge of interdisciplinary models of care delivery and case management. SIM 440 Collaboration for Improving Outcomes Assignments

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential II

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not
Demonstrated

Explain how the concept continuum of care is used in case management and within your organization
Explains how the concept continuum of care is used in case management and within your organization
States how the continuum of care is used in case management and within your organization
Lists how the concept continuum of care is used in case management and within your organization
Does not address the topic

Explain new services/programs that your organization is currently evaluating or performing that are assisting patients to reach
their health goals
Explains new services/programs that your organization is currently evaluating or performing that are assisting patients to reach
their health goals
States new services/programs that your organization is currently evaluating or performing that are assisting patients to reach
their health goals
Lists new services/programs that your organization is currently evaluating or performing that are assisting patients to reach
their health goals
Does not address the topic

Explain how these new services/programs can impact the bottom line of the organization.
Explains how new services/programs can impact the bottom line of the organization.
States how new services/programs can impact the bottom line of the organization.
Lists how new services/programs can impact the bottom line of the organization.
Does not address the topic

Choose a quality indicator and discuss how it can influence quality of care
Chooses a quality indicator and explains how it can influence quality of care
Chooses a quality indicator and states how it can influence quality of care
Chooses a quality indicator but doesn’t discuss how it can influence care
Does not address the topic

Assesses the practice of linking hospital reimbursement to
Assesses the practice of linking hospital reimbursement to
Explains the practice of linking hospital reimbursement to
Lists the practice of linking hospital reimbursement to
Does not address the topic

performance outcomes
performance outcomes
performance outcomes
performance outcomes

APA, Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation. SIM 440 Collaboration for Improving Outcomes Assignments
One to three errors in APA, Spelling, and Punctuation.
Four to six errors in APA, Spelling, and Punctuation.
Seven or more errors in APA, Spelling, and Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

Activity 5 Evidence-Based Practice and Case Management
Using your chosen chronic illness from the list below,

Hypertension
Chronic Obstructive Pulmonary Disease
Diabetes Mellitus type 2
Childhood Asthma

you will explore the use of evidence-based practice and how it is incorporated into case management patient care guidelines and pathways.

Identify and discuss current best practices. Address the importance of basing case management on current evidence.
Identify and evaluate published guidelines.
Identify and discuss clinical pathways and how they relate to your chosen illness.

Reading and Resources

Pizzi, Michael A,PhD., O.T.R./L. (2014). Promoting health, wellness, and quality of life at the end of life: Hospice interdisciplinary perspectives on creating a good death. Journal of Allied Health, 43(4), 212-20.
Annicka G M van der,Plas, Vissers, K. C., Francke, A. L., Donker, G. A., Jansen, W. J. J., Deliens, L., & Onwuteaka-Philipsen, B. (2015). Involvement of a case manager in palliative care reduces hospitalisations at the end of life in cancer patients; A mortality follow-back study in primary care. PLoS One, 10(7)
Meyer, Star,R.N., B.S.N. (2012). Care management role in end-of-life discussions. Care Management Journals, 13(4), 180-3.
Review the National Committee for Quality Assurance certification criteria.

Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes– Evidence-Based Practice and Case Management

Description: The baccalaureate graduate nurse will integrate evidence, clinical judgement, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

Course Competency: 4) Coordinate the care of individuals across the lifespan utilizing principles and knowledge of interdisciplinary models of care delivery and case management.

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential III

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Identify and discuss best practices
Identify and discuss best practices.
Identifies best practices and
minimally discusses
Identifies best practices
but does not discuss
Does not address section

Evaluates published guidelines
Evaluates published guidelines
Interprets published guidelines
Lists published guidelines
Does not address section

Appraises clinical pathways
Appraises clinical pathways
Interprets clinical pathways
Lists clinical pathways
Does not address section

APA, Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation. SIM 440 Collaboration for Improving Outcomes Assignments
One to three errors in APA, Spelling, and Punctuation.
Four to six errors in APA,
Spelling, and Punctuation.
Seven or more errors in APA, Spelling, and Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

SIM 440 Collaboration for Improving Outcomes Assignments Activity 6 Family Support Assessment
Case management is useful in a variety of settings. You will be using the nursing process to conduct an in-home assessment in Sentinel City® to develop a plan of care for a family. The process of collecting, analyzing, and synthesizing data from a variety of sources can help the nurse to gain an understanding of family strengths, values, and needs related to physical and social determinants of health to promote the health and well-being of the family unit.
Develop a Family Support Care Plan to address the needs of this family using your institutions’ care plan template or use this care plan template.

Include a properly formatted community health nursing diagnosis that addresses either preschool age children, single mothers, or pregnant women.
Increased risk of (disability, disease, etc.) among (community or population) related to (disability, disease, etc.) as demonstrated in or by (health status indicator, or etiological/causal statement).

Example: Increased risk of obesity among school-age children related to lack of safe outdoor play areas for children as demonstrated by elevated BMI rates.

Reading and Resources
Chapter 16 pages 297-316, Chapter 23 pages 395-404, Chapter 20 pages 367-375, Chapter 26 pages 439-447 in Fundamentals of Case Management Practice.
Review clinical guidelines of the AHRQ
Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes – Family Support Assessment

Description: Identify the determinants of health and illness of individuals and families using multiple sources of data.

Course Competencies: 2) Develop a holistic case management plan for a specified disease or population that incorporates the role of insurance, health care finance, and utilization of community resources. 4) Coordinate the care of individuals across the lifespan utilizing principles and knowledge of interdisciplinary models of care delivery and case management. SIM 440 Collaboration for Improving Outcomes Assignments

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice 5) Safety

BSN Essential VII

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Data
Includes detailed objective and subjective data
Lists objective and subjective data
Identifies only subjective or objective data
Does not address section

Nursing Diagnosis
Develops a nursing diagnosis (using NANDA) for an individual in the family unit
Outlines a nursing diagnosis (using NANDA) for an individual in the family unit but some elements are missing
Defines a nursing diagnosis for an individual in the family unit but is not appropriate for family member
Does not address section

Community Health Nursing Diagnosis
Develops a properly formatted community
health nursing diagnosis
Outlines a community health nursing diagnosis but
some elements are missing
Defines a community health nursing diagnosis that is not appropriate
Does not address section

Plan of Care
Designs a plan of care that is relevant to identified problems, issues, or concerns
Prepares a plan of care that addresses some of the problems, issues, or concerns.
Infers a plan of care that is not relevant to identified problems, issues, or concerns.
Does not address section

SMART Goal Statements
Develops 3 clear SMART goal statements (Specific, Measurable, Achievable, Relevant, Time-
Bound [realistic deadlines to
Develops 2 clear SMART goal statements (Specific, Measurable, Achievable, Relevant, Time-
Bound [realistic deadlines to
Develops 1 clear SMART goal statement and/or elements of the goal statement are missing or not clear
Does not address section

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meet goals/outcomes])
meet goals/outcomes])

Evidence-based Rationale
Illustrates evidence-based rationale to support nursing actions that address identified problem, issues, or concerns
Lists evidence- based rationale with minimal explanation for support of nursing actions r/t problem, issues, or concerns
Mentions evidence-based rationale with no support for nursing actions addressing problem, issues, or concerns. SIM 440 Collaboration for Improving Outcomes Assignments
Does not address section

Evaluation Plan
Designs an evaluation plan addressing each goal statement
Provides an evaluation plan addressing some of the goal
statements
Names an evaluation plan that doesn’t address each
goal statement
Does not address section

APA, Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation.
One to three errors in APA, Spelling, and
Punctuation.
Four to six errors in APA, Spelling, and
Punctuation.
Seven or more errors in APA, Spelling, and
Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

SIM 440 Collaboration for Improving Outcomes Assignments Activity 7 Home Safety Assessment
It is important to identify health issues or concerns that may impact an individual or family in any setting. This identification can help the nurse to address health promotion and disease prevention.
To complete this activity, you must complete the Family Support Assessment activity. Click on Enter Sentinel City®. Once in the city, click on the map to locate the apartment dwelling in Nightingale Square. Approach the door next to the laundromat and enter the apartment. Here you will complete the Home Safety Assessment by noting any health, safety, and environmental hazards in the apartment. Note as many of the hazards that you observe. Select and prioritize the top two hazards for health, safety, and environmental areas for a total of six hazards that the healthcare professional should address first:

#1 = most serious hazard-life threatening
#2 = second most important-potential to affect the most people or cause long-term injury

Try to avoid prioritizing the same hazard in multiple categories. Provide an evidence-based rationale and a recommendation for addressing the top two hazards in each category. Click the “Family Support Assessment” tab at the top of the screen and review the information on the form.
Reading and Resources
Chapter 16 pages 297-316, Chapter 23 pages 395-404, Chapter 20 pages 367-375, Chapter 26 pages 439-447 in Fundamentals of Case Management Practice.
Review clinical guidelines of the AHRQ
Additional Instructions:

**Family Support Assessment Required

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes – Home Safety Assessment

Description: Practice evidence-based public health nursing to promote the health of individuals, families, and groups.

Course Competencies: 2) Develop a holistic case management plan for a specified disease or population that incorporates the role of insurance, health care finance, and utilization of community resources. 4) Coordinate the care of individuals across the lifespan utilizing principles and knowledge of interdisciplinary models of care delivery and case management.

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice 5) Safety

BSN Essential VII

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Health, Safety, and Environmental Hazards
Identify and prioritize two health, two safety, and two environmental hazards in the home.
Lists and does not prioritize two health, two safety, and two environmental hazards in the home. SIM 440 Collaboration for Improving Outcomes Assignments
Identifies and prioritizes less than two health, safety, or environmental hazards in the home.
Does not address section

Evidence-based Rationale
Interprets evidence-based rationale to support prioritization and recommendations for addressing each identified hazard
Lists evidence- based rationale to support prioritization and recommendations for addressing each identified hazard
Interprets evidence-based rationale but does not provide support for prioritization or provides support but does not interpret evidence-based
rational
Does not address section

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

Activity 8 Regulatory Environment
Explain how healthcare exchanges change the concept of outpatient treatment. Many clinical information systems now embed practice guidelines and clinical pathways into their electronic medical record systems. Discuss some of the advantages and disadvantages of this. Describe demand management and how it can increase consumer involvement in care. Compare and contrast disease management and case management.
Reading and Resources

Ferrier, G. D., & Trivitt, J. S. (2013). Incorporating quality into the measurement of hospital efficiency: A double DEA approach. Journal of Productivity Analysis, 40(3), 337-355. https://search.proquest.com/docview/1448800469?accountid=169658
Search the site for US Department of Health and Human Services “Hospital Compare” and use the interactive database to compare and contrast health plans, hospitals, etc. How might you use this site with patients as a case manager?
Chapter 16 pages 297-316, Chapter 23 pages 395-404, Chapter 20 pages 367-375, Chapter 26 pages 439-447 in Fundamentals of Case Management Practice.
Review clinical guidelines of the AHRQ
Pizzi, Michael A,PhD., O.T.R./L. (2014). Promoting health, wellness, and quality of life at the end of life: Hospice interdisciplinary perspectives on creating a good death. Journal of Allied Health, 43(4), 212-20.
Annicka G M van der,Plas, Vissers, K. C., Francke, A. L., Donker, G. A., Jansen, W. J. J., Deliens, L., & Onwuteaka-Philipsen, B. (2015). Involvement of a case manager in palliative care reduces hospitalisations at the end of life in cancer patients; A mortality follow-back study in primary care. PLoS One, 10(7)
Meyer, Star,R.N., B.S.N. (2012). Care management role in end-of-life discussions. Care Management Journals, 13(4), 180-3.
Review the National Committee for Quality Assurance certification criteria.

Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes- Regulatory Environment

Description: The baccalaureate graduate nurse will demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state, national, and global healthcare trends.

Course Competency: 2) Develop a holistic case management plan for a specified disease or population that incorporates the role of insurance, health care finance, and utilization of community resources. SIM 440 Collaboration for Improving Outcomes Assignments

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential V

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Evaluate
Evaluates how healthcare exchanges can change the concept of outpatient treatment
Discusses how healthcare exchanges can change the concept of outpatient treatment
Lists how healthcare exchanges can change the concept of outpatient treatment
Does not address the topic

Explain
Explains the advantages and disadvantages of embedding practice guidelines and clinical pathways into electronic medical record
systems
Discusses the advantages and disadvantages of embedding practice guidelines and clinical pathways into electronic medical
record systems
Lists the advantages and disadvantages of embedding practice guidelines and clinical pathways into electronic medical record systems
Does not address the topic

Describe
Describe demand management and how it increases consumer involvement in care
Discusses demand management and how it increases consumer involvement in care
Lists demand management but doesn’t discuss how it increases consumer involvement in care
Does not address the topic

Compare and Contrast
Compares and contrasts disease management and
case management
Discusses disease management and case management
Lists disease management and case management
Does not address the topic

APA,
Grammar, Spelling, and Punctuation
No errors in APA, Spelling, and Punctuation.
One to three errors in APA, Spelling, and Punctuation. SIM 440 Collaboration for Improving Outcomes Assignments
Four to six errors in APA, Spelling, and Punctuation.
Seven or more errors in APA, Spelling, and Punctuation.

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

SIM 440 Collaboration for Improving Outcomes Assignments Activity 9 Role and Function
Describe the roles and functions of the nurse case manager in (1) acute care, (2) home care, and (3) primary care settings.
Often the case manager is a social worker rather than a nurse. What skills would a nurse need to have to better prepare to do a community health plan for a patient? Why are these skills important?
What are some of the approaches case managers use to promote the highest quality of care with careful use of resources? Think globally…how can palliative care and hospice services assist this strategy.
Reading and Resources

Chapter 1 in Fundamentals of Case Management Practice
Case Management Society of America
Pizzi, Michael A,PhD., O.T.R./L. (2014). Promoting health, wellness, and quality of life at the end of life: Hospice interdisciplinary perspectives on creating a good death. Journal of Allied Health, 43(4), 212-20.
Annicka G M van der,Plas, Vissers, K. C., Francke, A. L., Donker, G. A., Jansen, W. J. J., Deliens, L., & Onwuteaka-Philipsen, B. (2015). Involvement of a case manager in palliative care reduces hospitalisations at the end of life in cancer patients; A mortality follow-back study in primary care. PLoS One, 10(7)
Meyer, Star,R.N., B.S.N. (2012). Care management role in end-of-life discussions. Care Management Journals, 13(4), 180-3.
Review the National Committee for Quality Assurance certification criteria

Additional Instructions:

Submission Options

Choose One:
Instructions:

Paper

4 page paper. Include title and reference pages.

Rubric

Collaboration for Improving Outcomes- Role and Function

Description: The baccalaureate graduate nurse will contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes. SIM 440 Collaboration for Improving Outcomes Assignments

Course Competencies: 1) Assess the roles of the nurse case manager in the contemporary health care structure. 3) Examine the role of case management in end of life care including ethical and legal issues.

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence- Based Practice

BSN Essential VI

Area
Gold Mastery
Silver Proficient
Bronze Acceptable
Acceptable Mastery not Demonstrated

Roles and Functions
Explains the roles and functions of the nurse case manager in each acute care, home care, and primary care settings
Discusses the roles and functions of the nurse case manager in each acute care, home care, and primary care settings or explains two of
the three functions
Lists the roles and functions of the nurse case manager in acute care, home care, and primary care settings or explains one of the three functions
Does not address the topic

Details Skills
Fully details the skills a nurse would need to better prepare to do a community
health plan for a patient.
Discusses the skills a nurse would need to better prepare to do a community
health plan for a patient. SIM 440 Collaboration for Improving Outcomes Assignments
Lists the skills a nurse would need to better prepare to do a community
health plan for a patient.
Does not address the topic

Details Approaches
Fully details the approaches case managers use to promote the highest quality of care with careful use of
resources
Discusses the approaches case managers use to promote the highest quality of care with careful use of
resources
Lists approaches case managers use to promote the highest quality of care with careful use of resources
Does not address the topic

References
Provides two or more references.
Provides two references.
Provides one references.
Provides no references.

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SIM 440 Collaboration for Improving Outcomes Assignments

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