DB 3: What is utilization and case management?
How is this related to managed care and quality care and control issues?
How does APNP clinical expertise and patient management skills provide a foundation for utilization and case management?
Provide an example of how case management improves patient care outcomes. Use an EBP research article to support your case. Provide detailed examples.
Students are expected to:
Post an initial substantive response of 200-250 words to each
Please be sure to validate your opinions and ideas with citations and references in APA format.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses. DB 3: What is utilization and case management?
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
DB 3: What is utilization and case management?
When you have a health condition, it can feel like your options are limited. You may feel frustrated and out of control of your own care, but there’s good news: case management and utilization management can help improve access to health care for patients with limitations or conditions that impede their ability to receive treatment as well as improve the overall quality of their care by making sure they’re getting what they need when they need it.
Utilization and case management are different, but they both share the goal of helping people improve their health care outcomes. In utilization management, you are trying to get all of your medical services under control. Case managers help people understand what services they need and when those services will be needed.
Case management is a comprehensive approach to managing the care of a patient. It includes coordination of care across health care settings and links to community resources. Case managers work with patients and their families to coordinate services, ensure access to services, assist patients in meeting their goals and improve outcomes of disease management interventions.
Case managers help patients navigate the health system by:
Utilization management is the process of determining which services a patient needs, what type of service they require, and how often they need it. The goal of utilization management is to improve access to care by providing accessible and timely information about available treatments, services and facilities. This includes tracking the use of health care resources so that providers can make informed decisions about scheduling or referring patients for further evaluation or treatment.
In some cases, such as when you’re seeing your doctor for a checkup at the end of your annual physical exam (which typically happens every year), you may not have any idea whether or not there’s something wrong with you until after taking some tests like blood pressure readings or urine samples during this visit. But most visits are much less stressful because we’ve already had some time beforehand thinking about what questions might come up during our appointment together!
Case management and utilization management are two distinct yet related systems of care that can help improve access to health care for patients with limitations or conditions that impede their ability to receive treatment as well as improve the overall quality of their care by making sure they’re getting what they need when they need it.
Case management is best understood as a patient-centered system that includes coordination of care across health care settings, links to community resources and advocacy on behalf of patients. Utilization management helps a patient get more appropriate medical services by providing accessible and timely information about available treatments, services and facilities; helping identify gaps in treatment options; identifying potential risks associated with various procedures; coordinating follow-up appointments; providing educational materials such as brochures; offering assistance in filling out paperwork (e.g., Medicaid); arranging transportation when necessary (e.g., oxygen therapy).
Case management is a patient-centered system that includes coordination of care across health care settings and links to community resources. The case manager helps you get the most out of your health insurance, including making sure you have access to the right services when needed.
Case managers can help with many things:
So what’s the difference between utilization and case management? Well, as we’ve seen, they both help you get the right care at the right time. But there are some other differences too. For example, utilization management focuses on helping patients navigate through a complex health care system and find someone who can provide services in their area; case management helps people to understand their situation better so they can make better decisions about their health care needs.
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