Hypertension, or high blood pressure, is a serious medical condition that substantially increases the risk of catching kidney, heart, or brain complications. Given the severity of its outcomes, it is vital to address the problem during the early stages. Early treatment may reduce the risk of serious health complications (Fisher & Curfman, 2018). Some health facilities only provide one or two healthcare practitioners to handle cases of hypertension. These caregivers mainly include a primary care physician and a pharmacist. However, the severity of the disease demands the involvement of an array of medical practitioners. This is because hypertension patients need more than primary medical care and medication prescription; they need a proper diet, exercise, and good mental health. When more medical practitioners are introduced to handle these areas, coordinating medical care becomes difficult (Fisher & Curfman, 2018). Case management comes in handy as a collaborative process of assessing, planning, facilitating, and evaluating care coordination to meet a patient’s health needs and promote effective outcomes (Huque et al., 2018). The underlying philosophy of case management is that when a patient reaches an optimum level of functional capability and wellness, everyone gains. Case management is a means for attaining patient autonomy and welfare by identifying resources, facilitation of services, education, advocacy, and communication. This paper outlines a case management plan for hypertension.
Implementation Plan
Case management will involve assessing a patient’s needs and the linkage of that patient to the available resources and service. As such, case managers will act as facilitators than providers of patient services (Huque et al., 2018). Particularly on hypertension, case management will improve patient outcomes, self-management, and compliance with medical advice.
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The hospital case manager will be a nurse that will do both utilization review and discharge planning. By conducting utilization review, the case manager will match the patient’s care interventions and clinical picture to an evidence-based criterion (Stockbridge & d’Urso, 2015). This criterion will guide the case manager in determining suitable care settings for all service levels across the arc of hypertension care. The utilization review process will involve three activities; prospective, concurrent, and retrospective review. The case manager will conduct a prospective review before admission to determine whether scheduled procedures or services are medically necessary. A concurrent review will incorporate a review of the medical need for decisions made while patients with hypertension are in acute or post-acute settings. After treatment has been provided, the case manager will conduct a retrospective review of the coverage.
To conduct a complete utilization review process, the case manager must conduct precertification, review of continued stay, and transition of care (Stockbridge & d’Urso, 2015). After a patient’s admission to the facility, the case manager will conduct a first-level review to determine appropriateness. Medical necessity will determine whether a patient’s admission is reimbursable, justifiable, and appropriate. The case manager will also determine whether each day of continuous stay in the hospital is necessary and whether that day’s level of care is appropriate. He/she will also be tasked with determining the most needed and appropriate level of care, such as intermediate or intensive, as opposed to a medical-surgical floor level of care (Stockbridge & d’Urso, 2015). The last constituent of a complete utilization review will be assessing and monitoring systems to identify potential delays in care. In all these activities that comprise the utilization review process, the case manager must accurately document the level of care and medical necessity. This documentation must show a patient’s current state, why outpatient treatment will not be viable, and the dangers of failure to provide the specified levels of care.
Discharge planning will involve the development of personalized plans for patients who are leaving the hospital. According to Gonçalves-Bradley (2016), this process is crucial to the continuity of care. The case manager’s role in discharge planning will be ensuring that patients are discharged from the health facility at an appropriate time and that all post-discharge services are provided in an organized manner. This will not be solely the case manager’s task. Instead, it will be a team approach. The case manager will only be tasked with coordinating the following activities:
Evaluation of patients by qualified medical practitioners – Before the patient is discharged, the case manager will ensure that proper evaluation of the patient’s condition warrants a discharge to home-based care. If the patient needs to transfer to another facility, the case manager will also engage the medical practitioners in medical evaluations to support the transfer.
Discussion of discharge plans with patients or their representatives - These discussions should include the statement of whether a patient is likely to improve, information on diet and medications, extra equipment needed, and types of care required.
Arrangement for transfer to other care facilities or homecoming.
Determination of whether caregiver support or training is required.
Referral of patients to home care agencies or appropriate support establishments – The case manager should be in a position to recommend the best home care agencies based on the patient’s current state.
Arrangement for follow-up tests or appointments – The case manager will liaise with other medical practitioners to determine how the patient’s medical condition will be monitored after discharge.
Effective discharge planning will ensure that adequate care preparations are made. It will also reduce the chances of readmission, aid in recovery, and provide the correct prescription of medications (Henke et al., 2017). According to Gonçalves-Bradley (2016), “a discharge plan tailored to the individual patient probably brings about a small reduction in hospital length of stay and reduces the risk of readmission to hospital at three months follow-up for older people with a medical condition” (p. 4). Through discharge planning, the patient’s satisfaction with healthcare will be increased. However, discharge planning may not reduce the cost of health services.
Additionally, the case manager may negotiate health insurance benefits between insurers, providers, and patients. Through such negotiations, the case manager may help lower the costs of care.
Approach To Gain Buy-In From Key Stakeholders
As stated earlier, the case manager will only facilitate patient care. Thus he/she will require support from several stakeholders. Particularly for hypertension, the case manager will need help from a team of medical practitioners (de Fátima et al., 2018). These practitioners include the primary care physician, the pharmacist, the nurse practitioner, the therapist, and the personal trainer.
The primary care physician should be experienced in treating hypertension. His key roles will be evaluating the patient, determining the appropriate levels of care, and determining whether a day’s level of care is appropriate. The primary care physician will also assist in negotiations with insurance providers and patients concerning the cost of medication (de Fátima et al., 2018). The nurse practitioner should be specialized in cardiovascular care and internal medicine to assist in the formulation of hypertension treatment plans.
Since losing weight and maintaining a healthy weight are vital in hypertension treatment, the case manager will also work closely with the dietitian. The dietitian may also be specialized in the treatment of hypertension and will provide diet and nutrition advice to help control hypertension. Such information includes information on foods high in fiber and low in fat, and fruits and vegetables that help reduce blood pressure (Aronow, 2015). Dietitians and nutritional experts can create diet plans for hypertension patients to adhere to and help patients change their habits. Thus they will play a crucial role in the discharge planning process.
The pharmacist will also be instrumental in discharge planning. Since hypertension can involve taking several medications, pharmacists can be of great assistance (Aronow, 2015). Pharmacists are specialized in the use of medicines. They dispense prescription drugs to patients and offer expertise on their safe use. Thus they will provide valuable information on medications during discharge planning.
The therapist will assist patients in dealing with depression or stress related to hypertension. Such assistance may be necessary since chronic health conditions and side effects of medications can result in mental health issues (Aronow, 2015). The case manager will also consult with the personal trainer regarding the fitness routine. Since regular exercise is essential in treating hypertension, the personal trainer will offer guidance on the best training regime during treatment and after discharge. Thus he/she will be a significant player in the discharge planning process.
In addition to the healthcare providers, the case manager will need support from the utilization personnel. The family will also play a significant role in the entire case management process. As part of the social network involved in treating the hypertensive patient, the family will encourage personal attitudes linked to better health outcomes such as adherence to medication regimes, sharing of information, physical exercises, diet, and sleep. Family members can transmit courage, strength, and tranquility to hypertension patients, which makes them feel supported throughout the treatment process. Their support in the care management process will improve patients’ health outcomes.
Examination of Key Outcomes
The key outcomes of the project are:
Patient’s health outcomes are improved.
Readmission rates for discharged patients are reduced.
Better patient experience during the treatment process.
The main objective is to ensure that hypertension patients experience improved health at the end of the treatment process. This case management plan is tailored to ensure that all activities necessary for improving the patient’s blood pressure are incorporated. The plan will ensure that patients undergo all necessary treatment procedures and that competent healthcare providers conduct them. The plan will ensure that a patient’s condition is monitored throughout the process to determine instances when specific health interventions will be necessary. In the case of discharge, the plan provides for selecting the best places to take patients, whether to another healthcare facility or at home. Such a measure will only ensure that they receive appropriate medical care even after leaving the hospital. All these measures are aimed at improving the patient’s experience and ultimately improving their health.
In the case of discharge, it is necessary to minimize readmission rates (Henke et al., 2017). This plan puts forth a discharge planning process as the best way to minimize readmission rates. The discharge planning process will ensure that a patient’s medical condition is accurately monitored at home. Besides, the proposed discharge plan ensures the involvement of several medical practitioners in a patient’s care after discharge. In this way, the plan minimizes the risk of a patient’s condition deteriorating hence requiring readmission.
Conclusion
Hypertension is an aggressive and silent infection whose treatment calls for a collaborative effort. This case management plan is an exemplification of how hypertensive patients can be monitored through a combined effort. The plan shows the importance of collaboration between the case manager, the team of medical practitioners, and the patient’s family in treating hypertension. Based on the plan, the case manager has two main roles; conducting utilization review and discharge planning. The case manager will conduct major reviews on treatment processes before, during, and after treatment, and coordinate the entire medical team in developing a discharge plan. We expect to use the plan to improve patients’ experience, improve health outcomes, and reduce readmission rates for hypertension.
References
Aronow, W. S. (2015). Treating hypertension and prehypertension in older people: When, whom and how. Maturitas , 80 (1), 31-36.
de Fátima Mantovani, M., Kalinke, L. P., da Silva, Â. T. M., Arthur, J. P., Radovanovic, C. A. T., & Bortolato-Major, C. (2018). Effectiveness of case management performed by nurses for blood pressure control in adults with hypertension: a systematic review protocol. JBI database of systematic reviews and implementation reports , 16 (9), 1779-1784.
Fisher, N. D., & Curfman, G. (2018). Hypertension—a public health challenge of global proportions. Jama , 320 (17), 1757-1759.
Gonçalves‐Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S. (2016). Discharge planning from hospital. Cochrane database of systematic reviews , (1).
Henke, R. M., Karaca, Z., Jackson, P., Marder, W. D., & Wong, H. S. (2017). Discharge planning and hospital readmissions. Medical Care Research and Review , 74 (3), 345-368.
Huque, R., Nasreen, S., Ahmed, F., Hicks, J. P., Walley, J., Newell, J. N., & Elsey, H. (2018). Integrating a diabetes and hypertension case management package within primary health care: a mixed methods feasibility study in Bangladesh. BMC health services research , 18 (1), 811.
Stockbridge, H., & d’Urso, N. (2015). Application and outcomes of treatment guidelines in a utilization review program. Physical Medicine and Rehabilitation Clinics , 26 (3), 445-452.
