PURPOSE OF STUDY:Case management in the United Kingdom is an unregulated profession with no defined training pathway. The current case management workforce in the United Kingdom is drawn from diverse professional backgrounds and plays an important role in rehabilitation and supporting patients within a medico-legal context. There is limited empirical evidence describing the UK case management workforce and its practice. OBJECTIVES:The study aimed to (1) describe the demographic and professional characteristics of individuals working in case management in the UK and (2) identify common trends in case management practice. PRIMARY PRACTICE SETTING:Rehabilitation case management settings in the United Kingdom. METHODOLOGY AND SAMPLE:Cross-sectional survey using an online questionnaire tool distributed nationally via professional networks and organizations in the United Kingdom. The sample was adult practitioners working in the United Kingdom under the job title of case manager, or in roles consistent with the Institute of Registered Case Managers' (IRCM) definition of case management. The survey consisted of 29 questions eliciting data on the participants' background demographic information, professional practice information related to supervision, development and training, the client populations they manage, and practice-related information related to assessment, goal setting, and formal reporting. RESULTS:A total of 168 case managers completed the survey. Respondents were predominantly female, clinically trained, and experienced practitioners, with 166 working in the private sector supporting clients with complex neurological and trauma-related conditions. Engagement in continued professional development (CPD) and supervision was high, with most respondents reporting regular participation in both. However, only 78 respondents (46%) reported using standardized outcome measures in practice, and a wide variation in assessment tools was identified. Most respondents reported flexibility in assembling rehabilitation teams and frequent involvement in litigation-related work. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:This study provides the first national overview of the UK case management workforce, highlighting a predominantly experienced, clinically qualified but heterogeneous workforce. Although strong engagement in professional development and supervision is evident, variability in assessment practices and the absence of a formalized training pathway indicate a need for greater standardization and professional regulation. These findings support the development of structured education, competency frameworks, and initiatives such as the Institute of Registered Case Managers' Register to enhance consistency, governance, and public protection within the profession.This national cross-sectional survey provides evidence that can be used to support evidence-based policy and workforce planning and identify practice trends, gaps, and priorities. The findings from this research will serve as a benchmark for future studies. This research also strengthens the case for educational standards and professional development frameworks in the United Kingdom for the case management profession.
PURPOSE OF STUDY:To bring about positive behavioral changes-including greater self-efficacy, readiness, and contemplation of engaging in advance care planning-among Korean American older adults and their families who act as surrogate decision-makers and to increase the willingness of Korean American older adults to communicate end-of-life care preferences with potential surrogates and health care providers. PRIMARY PRACTICE SETTING:Adult daycare center in Southeastern Pennsylvania. METHODOLOGY AND SAMPLE:The study used a one-group, quantitative survey design with preintervention and postintervention assessments. The sample consisted of Korean American older adults in an adult daycare center. Data collection measured behavioral changes among older adults and their families as future surrogate decision-makers regarding advance care planning, as well as the older adults' willingness to share end-of-life care preferences with family members and health care providers. RESULTS:Ninety-one Korean American older adults and 24 surrogate decision-makers participated in the educational workshop. Following the workshop, both groups showed significant improvements in behavioral changes for advance care planning: Korean American older adults showed an average increase of 11.81 points ( p < .001) and surrogates 23.5 points ( p < .001). Among Korean American older adults, greater behavioral improvements were associated with willingness to share end-of-life care preferences with surrogates (OR = 1.24, p = .012) and to meet with health care providers (OR = 1.22, p < .001). Despite these improvements, only 27 of 91 Korean American older adults (29.67%) involved surrogates in the advance care planning process. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:This project, led by a nurse case manager, a registered nurse, and an advanced practice nurse clinician experienced in palliative and hospice community care, successfully encouraged Korean American older adults to become more aware of and prepared for advance care planning, as well as to discuss end-of-life care preferences with family members and health care providers. Although the initiative did not significantly increase meetings between older adults and their surrogates or providers, it did promote greater willingness to engage in end-of-life care discussions compared with previous studies. This approach is adaptable to other community settings and can be tailored to meet the linguistic and cultural needs of older adults with limited English proficiency in diverse ethnic groups.
ABSTRACT Perhaps a new type of case management is on the horizon? Currently called precision medicine, personalized medicine, or individualized medicine; it is based on selecting optimal and appropriate therapies built on a patients' genetics or cellular characteristics. As in all evolving medical treatments, this one has much to consider to go mainstream.
ABSTRACT Research and innovation are foundational to the transformation of professional case management and utilization review (CM/UR). Over the past decade, CM/UR has evolved significantly to address care complexity, workforce challenges, regulatory change, and administrative burden. Innovative workforce models, expanded community coordination, and advances in analytics, automation, artificial intelligence, and interoperability have improved efficiency, compliance, continuity of care, and patient outcomes while supporting value-based care. As regulatory requirements continue to evolve, sustained research and agile innovation remain essential to optimizing CM/UR delivery while maintaining a strong person-centered focus.
PURPOSE/OBJECTIVES:Medication adherence leads to improved health outcomes, significant decreases in health care costs, and reduced preventable rehospitalizations, but can be challenging for uninsured or underinsured patients facing financial barriers to medication access. Pharmacist interventions during hospital admission can ensure patients receive clinically optimized and financially sustainable medications at discharge. The purpose of this project is to expand one of the academic medical center's charitable care programs, the SMART (Streamlined Medication Access for high Risk patienTs) Formulary, which provides medication access to uninsured or underinsured patients in the ambulatory setting. PRIMARY PRACTICE SETTINGS:This manuscript will describe the process and methods for a pilot expanding the Formulary to inpatients discharging from an internal medicine floor. FINDINGS/CONCLUSIONS:After obtaining approval from the institutional Department of Care Coordination, the SMART team identified an appropriate internal medicine service and an appropriate time frame to pilot this intervention. The process for identifying patients, appropriate interventions, and communication methods were developed by a pharmacy resident with the oversight of the SMART Team and Care Coordination leadership. Case management and social workers on the medicine floor were oriented to the process and alerted how to contact the team via secure chat in the electronic medical record. During the study period, the SMART team would be alerted prior to discharge if a patient needed assistance with medication access. The SMART Team would then provide recommendations for sustainable medication coverage options prior to discharge. Outcomes were selected to characterize the effort and type of interventions, as well as the financial impact of the service on the medical center. Collected data included patient demographics, medication details, health care utilization (emergency department visits and hospitalizations), time spent pursuing medication access, and which medication access activities were completed prior to discharge. The SMART Team will compare the financial and health care utilization outcomes for the intervention group with a comparator group/benchmark which consisted of a historical cohort of patients discharged from the medicine service during the same period the previous year. This manuscript describes the framework for a service to provide prospective and retrospective pharmacist support for medication acquisition at discharge. Expansion of clinical pharmacist services to ensure charitable medication access for patients at hospital discharge requires input from several stakeholders and communication with provider teams, nurses, case managers, and social workers. This pilot is anticipated to improve sustainable access to evidenced-based medications, enhance the efficiency of charitable care funds, and reduce avoidable health care utilization. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:Uninsured and underinsured patients frequently encounter barriers to obtaining discharge medications, which contributes to medication nonadherence, preventable emergency department utilization, and suboptimal health outcomes, which are challenges that directly complicate effective care coordination by case managers. The pharmacist-led expansion of the SMART (Streamlined Medication Access for high-Risk patienTs) Formulary supports case management practice by integrating medication access planning into the discharge workflow. Through evidence-based formulary optimization and proactive enrolment in patient assistance programs, the initiative enables case managers to more effectively address social and financial barriers to treatment, engage patients in discharge planning, and support continuity of care beyond hospitalization. By improving access to essential medications at discharge, this model enhances longitudinal adherence, reduces avoidable utilization, and promotes more efficient use of charitable care funds. For case managers, the SMART Formulary functions as a scalable, interdisciplinary tool to advance pharmacoequity, strengthen discharge planning, and improve patient-centered outcomes across care transitions.
Purpose of Study:Caring for children and youth with special health care needs can be overwhelming for families. Higher levels of need often require more extensive and coordinated support. The burden of caring for children with complex health care needs can result in negative effects for parents and caregivers over time, thus increasing the risk of poor physical, emotional, and social well-being. Nursing care coordination is an evidence-based intervention that provides families with guidance and support by delivering safe and effective care. The quality of coordination, however, can profoundly shape families' experiences. The purpose of this study was to explore caregivers' perceptions of nursing care coordination provided by their child's public health plan through the lens of Kristen Swanson's Middle Range Caring Theory.Primary Practice Settings:The study was conducted across three counties in Florida.Methodology and Sample:A descriptive qualitative design was used. A total sample of nine caregivers and parents were interviewed. Semistructured interviews were used, and data were analyzed utilizing Colaizzi's interpretive method. Categories, subthemes, and themes were created.Results:The findings of this study highlighted caregivers' experiences of successes and challenges with their child's nurse care coordinators. The exploration of caregivers' perceptions led to two major themes: Triumphs of Nursing Care Coordination and Pitfalls of Nursing Care Coordination. The two themes produced five subthemes: (a) It Takes a Village, (b) Being my Voice, (c) Third Class Citizen, (d) Being Out of Touch, and (e) Just a Title.Implications for Case Management Practice:Strengths of care coordination include enhanced access to resources, clear guidance for navigating complex health care systems, and improved understanding of treatment options, all of which help alleviate caregiver strain. While nursing care coordination offers many benefits, challenges with the current infrastructure still exist. Nurses must advocate for policies that alleviate caseload pressures, strengthen continuity of care, and identify barriers like fragmented communication and inadequate staffing. Nurses can foster a sense of support by creating forums where parents and caregivers share experiences, while encouraging decision-makers to stay informed about the challenges these families face.
PURPOSE OF STUDY:The study aims to clarify the characteristics of and approaches to the ethical issues faced by care managers and to obtain suggestions for ethical care management through interviews with 16 care managers responsible for care management for older adults in Japan. PRIMARY PRACTICE SETTINGS:The subjects of this study were care managers responsible for care management of older adults in Japan, with at least 3 years of experience working at home care support offices or long-term care welfare facilities. METHODOLOGY AND SAMPLE:The research method was a qualitative study with a descriptive approach using semi-structured interviews, and a content analysis was conducted. RESULTS:Four categories of ethical issues were extracted: those related to the care plan, those occurring when collaborating with other professionals, those occurring within the organization, and those occurring within the system. There were three categories of approaches to ethical issues: continue to be involved to the satisfaction of the client, continue to share and negotiate issues with other professionals, and collaborate for the best interests of older adults. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:The core role of care managers is not being sufficiently fulfilled, such as care plans that prioritize the intention of the family or the interests of the care manager's own organization over respect for the autonomy and advocacy of older adults and a discrepancy between care management and social work. The two key implications for case management are that the very foundation for realizing person-centered case management lies in considering ethics, and that ethical issues must be addressed as organizational challenges.
OBJECTIVE:To describe how case managers can adapt their assessment practices to intentionally engage people living with aphasia in both the assessment and care planning process. PRIMARY PRACTICE SETTINGS:Home and community care. CONCLUSION:Case managers can support meaningful engagement for people living with aphasia by using evidence-based strategies and aphasia-friendly communication. A skilled, encouraging assessor amplifies the voice of the person with aphasia through a person-centered assessment and care planning process incorporating client input, caregiver insights, observational cues, and clinical documentation.
ABSTRACT:Transgender and gender diverse (TGD) youth experience disproportionately high rates of anxiety, depression, and suicide compared with their cisgender peers. Family relationships play a central role in shaping these outcomes, yet the specific influence of family acceptance on suicide risk during adolescent gender identity development remains insufficiently understood. This literature review examines evidence to evaluate how family acceptance, rejection, and gender-affirming behaviors affect suicidal ideation and suicide attempts among TGD adolescents younger than age 19. A structured search identified 15 peer-reviewed studies meeting the inclusion criteria. A narrative review identified four consistent themes: family rejection significantly increases suicide risks, family acceptance is one of the strongest protective factors against suicidality, gender-specific affirmation is uniquely protective beyond general emotional support, and family processes represent a modifiable intervention target. Findings underscore the critical role of the family system in suicide prevention among TGD youth. Enhanced clinical screening, proactive parental education, and development of structured family-based interventions are essential. Future research should prioritize longitudinal designs and demographic diversity to better understand how family acceptance evolves over time and influences developmental risk factors.
ABSTRACT:Perhaps a new type of case management is on the horizon? Currently called precision medicine, personalized medicine, or individualized medicine; it is based on selecting optimal and appropriate therapies built on a patients' genetics or cellular characteristics. As in all evolving medical treatments, this one has much to consider to go mainstream.
PURPOSE:To investigate the correlation between work engagement and self-efficacy among nurse case managers (NCMs) in China, analyzing the influencing factors and their implications for enhancing professional development and health care service quality. PRIMARY PRACTICE SETTINGS:The research was conducted in a Chinese hospital with NCMs position and training. METHODOLOGY AND SAMPLE:A cross-sectional design was used to recruit 76 NCMs through convenience sampling. The participants were registered nurses with at least 12 months of case management experience. Data were collected via online surveys, including demographic questionnaires, the NCM Self-Efficacy Questionnaire, and the Chinese version of the Utrecht Work Engagement Scale. Statistical analyses were performed using IBM SPSS 27.0. RESULTS:NCMs reported moderate levels of work engagement (73.42 ± 18.36) and self-efficacy (92.93 ± 14.56), with a significant positive correlation between them (r = 0.621, p < .001). Full-time NCMs exhibited higher scores in both constructs compared to part-time NCMs (p < .05). The workload had a significant impact on outcomes, with optimal self-efficacy observed at 11-20 new cases monthly. NCMs' major challenges included insufficient time/energy (86.8%), lack of institutional/departmental support (64.5%), and absence of dedicated positions (57.9%). Desired supports were hospital/leadership endorsement (94.7%), multidisciplinary collaboration (93.4%), and defined responsibilities (81.6%). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:The findings emphasize the need for systemic support, including establishing full-time NCM positions, optimizing workloads, and enhancing organizational support. Addressing these barriers can improve work engagement, self-efficacy, and service effectiveness, contributing to the sustainable development of case management in China's health care system.
BACKGROUND AND INTRODUCTION:Workplace bullying and incivility have continued to escalate across health care and pose serious risks to workforce well-being, organizational sustainability, and patient safety. This article builds on a prior four-part article series for this journal and examines emerging dimensions of bullying, including mobbing, gaslighting, cyberbullying, remote and virtual incivility, and the misuse of artificial intelligence. Recent data demonstrate a rising prevalence, disproportionate impacts across gender, race, ethnicity, and sexual minority status, and direct associations with burnout, turnover, medical error, and mortality. The piece also reviews the evolving regulatory, professional, and legislative responses to incivility and highlights an organizational quality-monitoring system that has yielded successful outcomes for health care settings. Practice strategies are also provided to mitigate bullying within the current health care workspaces (e.g., virtual or remote, onsite, or hybrid) and foster psychologically safe, ethical, and high-quality health care environments that heed the Quintuple Aim. PURPOSE/OBJECTIVES:Readers of this article will be able to (1) identify historic and current data regarding workplace bullying and incivility in health care, (2) define common terms associated with workforce bullying and incivility, (3) recognize fresh dimensions of workforce bullying and incivility, and (4) apply knowledge regarding quality monitoring systems to mitigate incivility in the health care workplace. PRIMARY PRACTICE SETTINGS:Health care organizations and systems, all touchpoints across the transitions of care. FINDINGS/CONCLUSIONS:Findings reveal how workplace bullying and incivility in health care have not diminished despite decades of professional standards, position statements, and accreditation efforts. Bullying has further escalated in prevalence, complexity, and harm over the past several decades creating significant risks for workforce well-being, organizational sustainability, and patient safety. COVID-19 amplified workforce stress, disrupted interprofessional relationships, while also accelerating the availability of remote roles. New role opportunities became impediments to effective workforce collaboration that advanced quality and safety concerns across practice settings. Ongoing awareness of the dimensions and consequences of workforce bullying by case management's interdisciplinary composition continues to be a critical way to inform successful standards of practice by all case managers. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE:Professionals who hesitate to confront and address incidents of disruptive and oppressive behaviors in the health care workspace contribute to poor quality of care. The Coronavirus (COVID)-19 pandemic brought new challenges to health care settings that contribute to high levels of workforce burnout, increased retention and attrition, and create tensions across critical fault lines of interprofessional interactions. In response, new types of bullying and incivility have appeared, fostering a dangerous culture of silence in the industry. This dynamic disrupts patient safety and quality care delivery. Understanding of these negative behaviors ensures greater promotion of workforce psychological safety, while also protecting patients and their families.
PURPOSE/OBJECTIVES:Morbidity and mortality among homeless populations in California continue to grow. Unsheltered individuals suffer from mental illness, physical disability, cognitive impairment, and acute and chronic illness. Many of these individuals qualify for care, yet encounters with nurses often miss these opportunities for care and referrals. We will examine the needs of a local homeless encampment in Southern California, to determine whether missed nursing contributed to their lack of access to health care resources. METHODS:Volunteers, licensed registered nurses, were trained for this project and consented to offer nursing care to a local unsheltered encampment. With oversight from the Institutional Review Board, data were collected in the camp to describe demographics and health care needs of those served. RESULTS:The unsheltered population is disproportionate in representation compared with the community at large (21.2% Black vs. 6.4% representation in the greater community and 51% White versus 55.2% in the community at large). Of 236 participants included in the investigation, 33 (14%) had access to a case manager. Having an assigned case manager was significantly associated with access to shelter ( p = .019, φc 0.457), and more commonly associated with challenges in activities of daily living ( p = .011, φc 0.352). Most participants had a recent encounter (discharge within 1 month) with nursing (n = 20,134, or 56.8%). CONCLUSION:This investigation offers concrete evidence of missed nursing care in unsheltered populations. In addition, access to a case manager was significantly associated with protection (access to shelter), a variable associated with better health outcomes.
ABSTRACT:Patient complexity continues to rise due to multimorbidity, co-occurring behavioral health needs, and persistent health-related social needs. Care/case managers (CMs) are pivotal in navigating fragmented systems, advancing health literacy, and reducing preventable utilization. This article describes why research and evidence-based practice (EBP) are essential to modern CM practice; summarizes national quality trends with emphasis on the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQI-90); and outlines a multisite initiative to reduce potentially avoidable hospitalizations. Practice changes are highlighted including standardized care plans, proactive visit cadence, and 7-day postdischarge follow-up. These initiatives were supported by cross-functional governance, analytics, and Plan-Do-Study-Act (PDSA) improvement cycles. Lessons learned underscore the impacts of behavioral health, social needs, and technology-enabled workflows. The article concludes with recommendations to leverage embedded predictive models and integrated dashboards to demonstrate outcomes and sustain performance.
Purpose of Study:This quality improvement project was designed to close a gap in capturing health literacy in adult patients with heart failure discharged from a hospital system. An opportunity existed to investigate if health literacy levels contribute to individuals' social factors and overall health. A priority focus was evident across healthcare organizations to address the social determinants of health (SDOH) for the populations served. Throughout the literature, limited health literacy is associated with higher hospital readmission rates. Pre-implementation data included 2023 heart failure readmission rate (19.02%) and baseline SDOH screenings (9,500) which noted housing, food insecurities, and transportation as greatest needs. There was no prior data analysis of how social factors may have impacted readmissions.Primary Practice Settings:Patients with recent hospitalization in Acute Care Hospitals with a known heart failure diagnosis; received health literacy screenings by the Registered Nurse (RN) Transitional Care Managers (TCMs) during their post-hospital discharge follow-up calls.Methodology and Sample:Pre-implementation period began in August 2024. Project launched in November 2024 with RN TCMs conducting assessments using the BRIEF (Health Literacy Screening Tool) during post-hospital discharge calls. Additional follow-up calls were required as the intervention for patients with limited literacy during their 30-day post-hospitalization transition period. Data collection occurred from November 2024 through June 2025.Results:The 8-month period included 1,543 high-risk hospital discharges, among them 580 patients with heart failure screened for health literacy; 517 patients had adequate health literacy, 44 had marginal health literacy, and 19 had limited health literacy. The intervention of additional follow-up calls for patients with limited health literacy achieved statistical significance in reducing readmissions.Implications for Case Management Practice:By implementing the BRIEF screening tool within an existing RN TCM workflow, it allowed for RN TCMs to interview patients with important questions during a vulnerable time for patients - transitioning from hospital to home. Expansion of health literacy assessments is vital for patients with any chronic condition, not just heart failure. RN TCMs identify the necessary interventions needed to support their patients and develop care plans. It is especially important to understand the needs specifically for patients with limited health literacy. Care management plays a pivotal role in patient advocacy by providing education and coordinating directly with providers to support patients' journey to better health.
