Development and Testing of the Relational and Structural Components of Innovativeness Across Academia and Practice for Healthcare Progress Scale.

OBJECTIVE: Using data from 5 academic-practice sites across the United States, researchers developed and validated a scale to measure conditions that enable healthcare innovations. BACKGROUND: Academic-practice partnerships are a catalyst for innovation and healthcare development. However, limited theoretically grounded evidence exists to provide strategic direction for healthcare innovation across practice and academia. METHODS: Phase 1 of the analytical strategy involved scale development using 16 subject matter experts. Phase 2 involved pilot testing the scale. RESULTS: The final Innovativeness Across Academia and Practice for Healthcare Progress Scale (IA-APHPS) consisted of 7 domains: 3 relational domains, 2 structural domains, and 2 impact domains. The confirmatory factor analysis model fits well with a comparative fit index of 0.92 and a root-mean-square error of approximation of 0.06 (n = 477). CONCLUSION: As the 1st validated scale of healthcare innovation, the IA-APHPS allows nurses to use a diagnostic tool to facilitate innovative processes and outputs across academic-practice partnerships.

A Typology of Innovations in Nursing.

OBJECTIVE: The purposes of this project were to identify innovations conceived from nurse faculty at a college of nursing and nurses in an academic medical center, examine their characteristics, and create a typology of nursing innovations. BACKGROUND: Innovation is a crucial component for progress in healthcare. Jobs to Be Done Theory suggests that to make progress in nursing, workers must be solution focused to answer problems. METHODS: This qualitative study used directed content analysis to evaluate survey responses of nurses in 1 university's academic and practice setting about solutions or innovations to achieve progress in their jobs. RESULTS: Fifty-seven examples of situations needing an innovative solution were coded and categorized by challenges to yield an 8 characteristic typology in nursing innovation. CONCLUSIONS: These findings serve as a guide for nurse executives to understand and leverage how innovations are conceptualized and translated in academia and practice.

Health care innovations across practice and academia: A theoretical framework.

BACKGROUND: An innovation scholarly interest group used the Jobs to Be Done Theory from the business literature to provide insight into the solution-focused progress that nurses are trying to make in challenging situations. PURPOSE: This article presents a theoretical framework for understanding the progress nurses are trying to make through health care innovations across both practice and academic environments. METHOD: This was a qualitative descriptive study using directed content analysis. We used the Jobs to Be Done Theory to guide the development of the semistructured questionnaire and the interpretation of findings. FINDINGS: A theoretical framework of nursing innovations was derived to summarize and visually display the pathways and linkages of challenges, innovations, and impact domains of nursing innovations. Situations and opportunities arise within the context of interconnectedness and can lead to health care innovations in care delivery, patient care interventions, role transitions, research and translational methods, communication and collaboration, technology and data, teaching methods, and processes to improve care. DISCUSSION: This theoretical framework offers insight into the dynamic interactions of academic-practice partnerships for innovation. Workplace situations are interconnected and can result in needed innovations designed to impact care delivery.

Case Management Effectiveness on Health Care Utilization Outcomes: A Systematic Review of Reviews.

Case management is a cost-effective strategy for coordinating chronic illness care. However, research showing how case management affects health care is mixed. This study systematically synthesizes and critically evaluates evidence in systematic reviews of health care utilization outcomes from case management interventions for the care of chronic illnesses. Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions. There was evidence that these interventions positively reduced health care utilization; however, results were mixed. These results and the implications of this review of reviews may be valuable for clinical practitioners, health care researchers, and policymakers.

Barriers in Case Managers' Roles: A Qualitative Systematic Review.

The challenges faced by case managers when implementing case management have received little focus. Several qualitative studies have been published that may be able to shed light on those challenges. This study is a systematic review of qualitative literature to identify barriers case managers have when implementing case management. Five electronic bibliographic databases were systematically searched, and 10 qualitative studies were identified for inclusion in the review which were published from 2007 to 2016. Through thematic synthesis of findings, five themes were identified as barriers to case management implementation: unclear scope of practice, diverse and complex case management activities, insufficient training, poor collaboration with other health-care providers, and client relationship challenges. This review study suggested that standardized evidence-based practical protocols and certification programs may help overcome case managers' barriers and improve case management practices. Health policymakers, case management associations, and health-care management researchers should develop educational and practical supports for case managers.

Nurse Leader DNP Capstone Projects Evaluation: An Action Framework.

BACKGROUND: Little is known about available guidelines that can be used to evaluate health systems' Doctor of Nursing Practice (DNP) capstone projects. OBJECTIVES: The twofold purpose of this study was to identify the scope of nurse executive leadership practices, as demonstrated in final health systems' DNP Projects and propose a framework to guide evaluating health systems' DNP capstone projects. METHODS: This qualitative study used content analysis to evaluate DNP project posters of 10 health systems' DNP students graduating from one Midwestern college of nursing. Students were engaged in activities pertinent to managerial and executive-level nurse leaders. RESULTS: Students were engaged in activities pertinent to both managerial and executive level nurse leaders and followed AONE competencies. Leadership styles were operational and transformational. Six types of activities were identified. Leadership activities and themes were organized into a framework for action that can guide curriculum. CONCLUSIONS: The Framework for Action themes can be used to coach students in nurse manager or executive roles and identify developmental needs of students. IMPLICATIONS FOR NURSING: A specific new competency on impact is indicated. Use of simulation techniques is an opportunity in health systems education.

Scoping Review of Nursing Case Management in the United States.

The purpose of this study is to identify issues of case management (CM) interventions in the United States in recent studies and to identify implications for future research into CM. This study was guided by the following framework for a scoping review. Multiple electronic databases were searched to identify studies published between 2007 and 2016 in the United States and related to nursing CM. Five weaknesses were identified: no clear and consistent definition of CM, lack of theoretical frameworks, lack of standard guidelines in CM practice, lack of precise CM dosage and of process measures, and limited reports of explicit role of nurse case managers and role confusion by nurses. Three strengths were also identified. More rigorous and continuous efforts to develop theoretical frameworks and evaluation tools, as well as clear definitions and precise role descriptions, are required for future research and practice into CM.

Leadership for Transitions of Care: An Active Learning Innovation.

Active learning assignments can be achieved in online discussions, resulting in creative linkages for innovation. This article describes how the teaching strategy of active learning assignment evolved into a group of student learners engaging in the development of a creative advanced clinical care scenario in an online graduate core course on leadership and management. The advanced clinical scenario that resulted from the students envisioning the assignment through the continuum of care was innovative and creative. Most importantly, the scenario stimulated vigorous conversation and excitement over the assignment, which promoted learning, pride in accomplishment, and on-the-job impact. This article serves as a model of ways to engage students in active learning for synthesis and evaluation to enable creativity and innovation.

Clinical leadership development and education for nurses: prospects and opportunities.

With the implementation of the Affordable Care Act, elevated roles for nurses of care coordinator, clinical nurse leader, and advanced practice registered nurse have come to the forefront. Because change occurs so fast, matching development and education to job requirements is a challenging forecasting endeavor. The purpose of this article is to envision clinical leadership development and education opportunities for three emerging roles. The adoption of a common framework for intentional leadership development is proposed for clinical leadership development across the continuum of care. Solutions of innovation and interdependency are framed as core concepts that serve as an opportunity to better inform clinical leadership development and education. Additionally, strategies are proposed to advance knowledge, skills, and abilities for crucial implementation of improvements and new solutions at the point of care.

Evidence-based nurse case management practice in community health.

PURPOSE OF STUDY: The purpose of this study was to investigate and compare the type of nurse case managers' (NCMs') practice on patients' quality outcomes in community settings. PRIMARY PRACTICE SETTING(S): Nurse case management (CM) practice with NCMs in community-based settings. METHODOLOGY AND SAMPLE: The design of this study was an exploratory, descriptive secondary analysis of 4 types of service by 11 NCMs, delivered to selected Medicare beneficiaries in community settings. Descriptive statistics and ANOVA tests were calculated. RESULTS: The majority of CM services were delivered in home care services in the community. Most of the 4 types of services-home, telephone, clinic, and mixed care-positively changed patients' quality measure outcomes-self-care activities of daily life, quality of life, and well-being. However, there were no modes that were statistically significant in patients' quality measure outcomes at the p < .05 level in the 2-year time frame. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: It is imperative to know the most effective and efficient types of CM services in community health for evidence-based NCMs practice. The results contribute to understanding how community health nurses may choose to select home care interventions for effectiveness. Thus, NCMs' practice needs to be capitalized on by practicing health administrators for health care management services within the current dynamic health policy environment.

An integrative review of case management for diabetes.

PURPOSE/OBJECTIVES: The purpose of this integrative review is to examine the effectiveness of case management for improving health outcomes in patients with diabetes mellitus as found in the literature from 2000 to 2010. PRIMARY PRACTICE SETTING: Diabetes case management in health care settings. FINDINGS/CONCLUSIONS: Case management is an effective intervention for glycemic control and is cost-effective. Evidence is building for its use in primary care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case management can be an important intervention for diabetes care in primary care and community settings. With evidence at the level of rigor of randomized controlled trials, case management significantly improved biophysiological, psychosocial, preventive, and adherence outcomes. Thus, case management can be an important aspect of effectiveness in health care services delivery within a reconfigured delivery system.

Achieving "meaningful use" of electronic health records through the integration of the Nursing Management Minimum Data Set.

OBJECTIVE: To update the definitions and measures for the Nursing Management Minimum Data Set (NMMDS). BACKGROUND: Meaningful use of electronic health records includes reuse of the data for quality improvement. Nursing management data are essential to explain variances in outcomes. The NMMDS is a research-based minimum set of essential standardized management data useful to support nursing management and administrative decisions for quality improvement. METHODS: The NMMDS data elements, definitions, and measures were updated and normalized to current national standards and mapped to LOINC (Logical Observation Identifier Names and Codes), a federally recognized standardized data set for public dissemination. RESULTS: The first 3 NMMDS data elements were updated, mapped to LOINC, and publicly disseminated. CONCLUSIONS: Widespread use of the NMMDS could reduce administrative burden and enhance the meaningful use of healthcare data by ensuring that nursing relevant contextual data are available to improve outcomes and safety measurement for research and quality improvement in and across healthcare organizations.

Case management workforce in the United States.

PURPOSE: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. DESIGN: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). METHODS: Descriptive statistics, Chi-square tests, and correlation coefficients were calculated. FINDINGS: The majority of the case-management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN-CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed-care enrollees. CONCLUSIONS: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce. CLINICAL RELEVANCE: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging-of-the-workforce issues in the US.

The evidence base for case management practice.

Little is known about the role performance of case managers, who come from a variety of professional disciplines. The purpose of this secondary analysis is to identify and compare case management (CM) activities and knowledge elements by professions and by work settings. In an online field survey conducted by the Commission for Case Manager Certification in 2004, 4,419 case managers rated the frequency and importance of 103 activities (8 domains) and 64 knowledge statements (6 domains). Nursing and social work showed a relatively similar pattern as to their role activities and knowledge factors for CM practice. Similar patterns were seen in work settings: between hospitals and rehabilitation facilities; health insurance companies and managed care organizations; and CM companies, workers' compensation agencies, and third-party administrators. These results indicate that there is evidence for how to develop CM programs consistent with both organizational characteristics and strengths of the nursing profession.

Iowa Case Management for Rural Drug Abuse.

OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.

Integrating the nursing management minimum data set into the logical observation identifier names and codes system.

This poster describes the process used to integrate the Nursing Management Minimum Data Set (NMMDS), an instrument to measure the nursing context of care, into the Logical Observation Identifier Names and Codes (LOINC) system to facilitate contextualization of quality measures. Integration of the first three of 18 elements resulted in 48 new codes including five panels. The LOINC Clinical Committee has approved the presented mapping for their next release.

Acuity and case management: a healthy dose of outcomes, part III.

PURPOSE OF STUDY: This is the third of a 3-part series presenting 2 effective applications--acuity and dosage--that describe how the business case for case management (CM) can be made. In Part I, dosage and acuity concepts were explained as client need-severity, CM intervention-intensity, and CM activity-dose prescribed by amount, frequency, duration, and breadth of activities. Concepts were presented that related the practice of CM to the use of evidence-based practice (EBP), knowledge, and methods and the development of instruments that measure and score pivotal CM actions. Part I also featured a specific exemplar, the CM Acuity Tool, and described how to use acuity to identify and score the complexity of a CM case. Part II further explained dosage and 2 acuity instruments, the Acuity Tool and AccuDiff. Part III presents linkage to EBP and practical applications. PRIMARY PRACTICE SETTING(S): The information contained in the 3-part series applies to all CM practice settings and contains ideas and recommendations useful to CM generalists, specialists, supervisors, and business and outcomes managers. The Acuity Tools Project was developed from frontline CM practice in one large, national telephonic CM company. METHODOLOGY AND SAMPLE: Dosage: A literature search failed to find research into dosage of a behavioral intervention. The Huber-Hall model was developed and tested in a longitudinal study of CM models in substance abuse treatment and reported in the literature. Acuity: A structured literature search and needs assessment launched the development of the suite of acuity tools. A gap analysis identified that an instrument to assign and measure case acuity specific to CM activities was needed. Clinical experts, quality specialists, and business analysts (n = 7) monitored the development and testing of the tools, acuity concepts, scores, differentials, and their operating principles and evaluated the validity of the acuity tools' content related to CM activities. During the pilot phase of development, interrater reliability testing of draft and final tools for evaluator concordance, b testing for content accuracy and appropriateness, and representative sample size testing were done. Expert panel reviews occurred at multiple junctures along the development pathway, including the 5 critical points after initial tool draft and both before and after b-test (n = 5) and pilot-test (n = 28) evaluations. The pilot testing body (n = 33) consisted of a team of case managers (n = 28) along with quality analysts (n = 2), supervisory personnel (n = 2), and the lead product analyst (the developer). Product evaluation included monitoring weekly reports of open cases for the 28 case managers for 3 months (June-August 2000). RESULTS: The Acuity Tools Suite was used to calculate individual case acuity, overall caseload acuity profiles, case length, and acuity differentials. Normal distributions and outliers were analyzed and the results were used for internal quality improvement and outcomes monitoring. IMPLICATIONS FOR CM PRACTICE: To show value, case managers need to access the evidence base for practice, use tools to capture quantities of intervention intensity, and precisely specify the activities that produce better outcomes. Acuity and dosage can help case managers explore and fully describe their own practice in ways that can be measured, and thus provide data and evidence that contributes to the accumulating body of definitive proof regarding the exceptional worth of CM. Proving business and professional worth in CM through EBP is a clarion call that case managers must heed and an innovation that all case managers can practice.

Acuity and case management: a healthy dose of outcomes, part II.

PURPOSE: This is the second of a 3-part series presenting 2 effective applications-acuity and dosage-that describe how the business case for case management (CM) can be made. In Part I, dosage and acuity concepts were explained as client need-severity, CM intervention-intensity, and CM activity-dose prescribed by amount, frequency, duration, and breadth of activities. Part I also featured a specific exemplar, the CM Acuity Tool, and described how to use acuity to identify and score the complexity of a CM case. Appropriate dosage prescription of CM activity was discussed. Part II further explains dosage and presents two acuity instruments, the Acuity Tool and AccuDiff. Details are provided that show how these applications produce opportunities for better communication about CM cases and for more accurate measurement of the right content that genuinely reflects the essentials of CM practice. PRIMARY PRACTICE SETTING(S): The information contained in the 3-part series applies to all CM practice settings and contains ideas and recommendations useful to CM generalists, specialists, and supervisors, plus business and outcomes managers. The Acuity Tools Project was developed from frontline CM practice in one large, national telephonic CM company. METHODOLOGY AND SAMPLE: Dosage: A literature search failed to find research into dosage of a behavioral intervention. The Huber-Hall model was developed and tested in a longitudinal study of CM models in substance abuse treatment and reported in the literature. Acuity: A structured literature search and needs assessment launched the development of the suite of acuity tools. A gap analysis identified that an instrument to assign and measure case acuity specific to CM activities was needed. Clinical experts, quality specialists, and business analysts (n = 7) monitored the development and testing of the tools, acuity concepts, scores, differentials, and their operating principles and evaluated the validity of the Acuity Tools' content related to CM activities. During the pilot phase of development, interrater reliability testing of draft and final tools for evaluator concordance, beta (beta) testing for content accuracy and appropriateness, and representative sample size testing were done. Expert panel reviews occurred at multiple junctures along the development pathway, including the 5 critical points after initial tool draft and both before and after beta-test (n = 5) and pilot-test (n = 28) evaluations. The pilot testing body (n = 33) consisted of a team of case managers (n = 28) along with quality analysts (n = 2), supervisory personnel (n = 2), and the lead product analyst (the developer). Product evaluation included monitoring weekly reports of open cases for the 28 case managers for 3 months (June-August 2000). RESULTS: The Acuity Tools suite was used to calculate individual case acuity, overall caseload acuity profiles, case length, and acuity differentials. Normal distributions and outliers were analyzed and the results used for internal quality improvement and outcomes monitoring. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: To show value, case managers need to access the evidence base for practice, use tools to capture quantities of intervention intensity, and specify precisely the activities that produce better outcomes. Acuity and dosage can help case managers explore and fully describe their own practice in ways that can be measured. This data-driven evidence contributes to the accumulating body of definitive proof regarding the exceptional worth of CM. Proving business and professional worth in CM though evidence-based practice is a clarion call that case managers must heed and an innovation that all case managers can practice.

Acuity and case management: a healthy dose of outcomes, part I.

PURPOSE OF STUDY: This article presents acuity and dosage as two concepts that describe how the business case for case management (CM) can be made. Dosage and acuity concepts are explained as client need-severity, CM intervention-intensity, and CM activity-dose by amount, duration, extent, and timing. Concepts are related to the practice of CM using evidence-based knowledge and methods to develop instruments that measure and score pivotal CM actions. The purpose of this series of three articles is to introduce the two concepts of dosage and acuity, discuss their importance for making the business case for CM and for translation into evidence-based practice, and present a powerful example of how they can be used in everyday CM. The articles feature a specific exemplar, the CM Acuity Tools project, and explain how the melding of the acuity and dosage innovations will improve the capture of CM outcomes. Part I focuses on the CM Acuity Tool(c) instrument. PRIMARY PRACTICE SETTING(S): The article's information applies to all CM practice settings, and contains ideas and recommendations useful to CM generalists, specialists, supervisors, and outcomes managers. The Acuity Tools Project was developed from frontline CM practice in one large, national telephonic CM company. METHODOLOGY AND SAMPLE: For dosage, the Huber-Hall Dosage Model and its testing are described and explained. The intersection of dosage and acuity is analyzed. For the Acuity Tools Project, a structured literature search and needs assessment launched the development of the suite of acuity tools. The resulting gap analysis identified that an instrument to assign and measure case acuity specific to CM activities was needed. Clinical experts, quality specialists, and business analysts (n = 7) monitored the development and testing of the tools, acuity concepts, scores, differentials, and their operating principles, and evaluated the validity of the acuity tools' content related to CM activities. During the pilot phase of development, interrater reliability testing of draft and final tools for evaluator concordance, beta (beta) testing for content accuracy and appropriateness, and representative sample size testing were done. Expert panel reviews occurred at several junctures along the development pathway, including after initial tool draft and both before and after beta-tests (n = 5) and pilot tests (n = 28). The pilot testing body (n = 33) consisted of a team of case managers (n = 28) along with quality analysts (n = 2), supervisory personnel (n = 2), and the lead product analyst (the developer). Product evaluation included monitoring weekly reports of open cases for the 28 case managers for 3 months (June to August 2000). RESULTS: Positive results generated approval from the expert review panel to apply the suite of acuity tools beyond (1) the initial draft phase, (2) the test population phase, and then (3) at a national CM organization level. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This article defines and discusses acuity and dosage as two practical conceptual tools that successfully unite clinical quality and business practices and measure and analyze CM activities. The CM Acuity Tool(c) is a master conceptual framework in three dimensions that synthesizes key components of CM practice, organized into indicators, drivers, and subdrivers. To show value, case managers need to access the evidence base for practice, use tools to capture quantities of intervention-intensity, and specify the activities that produce better outcomes.

Balanced scorecards for performance management.

Nurse administrators who manage nursing case management programs are challenged to demonstrate the improved quality of patient care and financial outcomes to their organization that result from such programs. This article introduces the balanced scorecard and discusses its benefits and practical concerns for adopting the scorecard. The balanced scorecard is a useful performance management tool used to both evaluate and direct case management performance in meeting organizational missions and strategies.