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A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare).
The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...
In this context: "A Case is a proceeding that involves actions taken regarding a subject in a particular situation to achieve a desired outcome" [1] and it is derived from the concept of case management used e.g. in the legal and medical worlds.
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates .
Case management (US health system), a specific term used in the health care system of the United States of America; Medical case management, a general term referring to the facilitation of treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals; Legal case management, a set of management ...
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
The nursing model is a consolidation of both concepts and the assumption that combine them into a meaningful arrangement. A model is a way of presenting a situation in such a way that it shows the logical terms in order to showcase the structure of the original idea. The term nursing model cannot be used interchangeably with nursing theory.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...