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The role of ED case management in quality improvement

Case Management Weekly, July 25, 2007

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An ED case manager is uniquely positioned to provide quality oversight of patient care and proactively and positively affect outcomes as patients access care in this critical and high-volume portal of entry to the care continuum. Depending on the organizational needs and the scope of the role, ED case managers can interact with both outpatients and newly-designated inpatients, and they have responsibilities in the following areas relative to quality management (QM):

• Assisting patients with access to primary care
• Preventing inappropriate hospital admissions and readmissions
• Identifying quality issues and supplying data about vendors or other healthcare providers to their case management/QM/contracting departments
• Ensuring that appropriate patients are identified at the point of admission and placed on evidence-based guidelines or protocols, enhancing quality of care and clinical outcomes, as well as improving their organizational compliance with pay-for-performance measures from various regulatory and payer sources

Source: "Emergency Department Case Management: Strategies for Creating and Sustaining a Successful Program", to be published August 2007, by HCPro, Inc.

Other articles of interest:

Study: Preventable deaths linked to quality initiatives

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