Does case management matter as a hospital cost-control strategy?

Occupational rehabilitation in Hong Kong: current status and future needs

INTRODUCTION

This paper reviews the development of occupational rehabilitation in Hong Kong, both in terms of the science as well as the service for injured workers. Besides, it also reviews the existing Employees' Compensation Ordinance for work injury to illustrate how the policy could influence the success and development of the discipline.

METHODS

Five experienced occupational rehabilitation providers, including 1 occupational medicine specialist, 3 occupational therapists, and 1 physiotherapist critically reviewed the past and current development of occupational rehabilitation in Hong Kong as well as the local contextual factors, which could influence its future development.

RESULTS

Since the enactment of the Employees' Compensation Ordinance in the 1950s, there have been progressive improvements in the field of occupational rehabilitation in Hong Kong. Services in the early years were mostly based on the biomedical model, where doctors and patients tended to focus on clinical symptoms and physical pathology when making clinical decisions. Since then, remarkable academic achievements have been made in the field locally, from the validation of clinical instruments for assessment of work capacity, assessment of employment readiness to the evaluation of efficacy of interventional programs for injured workers focusing on work related outcomes. However, there has been a relatively lack of progress in the development of related policies and implementation of related programs for occupational rehabilitation. There is no built in linkage between rehabilitation, compensation and prevention in the current system in Hong Kong, and there is no rehabilitation policy specific to those workers with occupational diseases and injuries.

CONCLUSIONS

There are still deficiencies in the development and provision of occupational rehabilitation services in Hong Kong. Incorporation of requirements for occupational rehabilitation at the legislation and policy levels should be seriously considered in the future. Besides, the development of the Occupational Medicine subspecialty in the public hospital system in Hong Kong is considered a facilitator to the future development of occupational rehabilitation in Hong Kong.

Leaders in hospital-based social work: the roles and functions of directors of social work in the case management model

PURPOSE

The purpose of this research is to provide an overview of the management skills and competencies required by a director of social work as they perform their multiple roles and functions in order to effectively manage a medical social work team to better serve the needs of patients through the new hospital-based case management model.

DESIGN/METHODOLOGY/APPROACH

This is a conceptual paper that reviews the literature on managerial roles, management functions, and skills and competencies of directors of social work. Management frameworks that are applicable under the case management model are discussed. Interviews with five directors of social work and their perceptions are described.

FINDINGS

Managing a department that is going through continuous changes is often difficult.

PRACTICAL IMPLICATIONS

This paper has practical implications for general health care managers and specifically, directors of social work, to develop skills and gain competencies to be successful in today's evolving health care environment This research also has practical implications for social workers to gain insight into productive and effective ways to collaborate with members of an interdisciplinary team.

ORIGINALITY/VALUE

This paper is original and of value to those working in social work and in the health care field to develop their skills and competencies as they perform new roles and functions in the complex health care environment.

Estimating clinical and economic impact in case management programs

Case management programs are commonly offered by health plans, hospitals, freestanding case management vendors, and others to various purchasers of these services. Case management programs are materially different from standard medical management or disease management programs in a number of ways. The patients have complex medical conditions combined with many other variables that tend to increase their costs and patterns of utilization. Purchasers of case management services frequently demand some form of performance guarantees as evidence that these case management programs are reducing utilization and medical costs. Inherent challenges of high variation in clinical and cost characteristics of the case management population make it difficult to develop standard return on investment performance guarantees. There are, however, other methodologies and statistical approaches to measure and evaluate program performance. We seek to outline major limiting issues that differentiate case management financial impact analyses from other clinical programs, and to define a framework for beginning a dialogue between suppliers and purchasers of these services to create a program value proposition.

Neonatal intensive care unit census influences discharge of moderately preterm infants

OBJECTIVE

The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants.

DESIGN/METHODS

In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge.

RESULTS

There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates.

CONCLUSIONS

Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions.