What gold lies in your CM program?
Make your paths, quality tools data-rich
The data your case management department collects might be more valuable than you realize, but only if you know how to analyze and report that information so others can use it.
In fact, the case management department itself is one of the first beneficiaries of a comprehensive data collection program because the information demonstrates the department's effectiveness. But case management departments generally have not done well in providing useful information from their data to managed care companies or to those who can make changes to the patient care process, says Judy Homa-Lowry, RN, BS, CPHQ, director of quality improvement for The Delta Group in Greenville, SC.
Only recently have hospital administrators and case managers alike realized how important the type of data they collect and procedures they perform can be. Typically, managed care organizations (MCOs) want data related to morbidity and mortality. But payers may start to look more specifically at complications, such as readmissions, cesarean rates, infection rates, and emergency department visits for asthma patients, Homa-Lowry notes.
Why should case managers be keeping this type of data? "You need data anyway to show fluctuations," Homa-Lowry says. Most importantly, however, is that clinical data will demonstrate the effectiveness of your case management program.
For example, if you start to see an area where mortality and costs are going up while patient satisfaction and productivity are going down, having this data will demonstrate how and where you can make a difference to your administration and managed care companies. Data can be used to first make improvements or find solutions, then share the results with the MCO.
Homa-Lowry explains that she sees two common problems with case management data. "Either they have the data, and they don't bring it to one spot, or they don't have it to begin with," she says.
Part of the problem in collecting data lies in communicating with staff about the importance of the data being collected. Let staff know exactly how the information they gather is used, and the importance to the hospital in terms of managed care contracting or in quality improvement results. Then, follow up by sharing the results with those who can make changes, including the staff, physicians, administrators, and managed care organizations.
One way to make the data easy to understand and useful immediately is to stratify your results, notes Homa-Lowry. Stratifying data involves breaking the information down into categories such as patient acuity or patient group. Ideally, stratify your results into product lines, but if you don't have enough information for each product line, organize your data by DRG, Homa-Lowry advises.
"One reason we roll it up this way is because if we make changes in one area, the same problem will manifest itself in another area," Homa-Lowry notes. "You end up chasing the same problem around. Whereas, if you deal with it at a product line or organizational level, you might be able to do something about it." *
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