Assisting Complex Patients Regain Physical and Mental Health
The Integrated
Case Management Manual
Assisting Complex Patients Regain Physical and Mental Health
Supplemental Appendices
oger G. Kathol, MD, acquired extensive experience in the clinical integration of general medi- cal and mental health services for complex patients as the director of a Complexity Intervention Unit (the new term for Medical Psychiatry Unit) at the University of Iowa Hospitals between 1986 and 1999. Thereafter, he assisted in the integration of physical and mental health care management as medical director at Blue Cross Blue Shield of Minnesota for several years. As president of Carte- sian Solutions, Inc., he has consulted to numerous national and international organizations, hospitals and clinics, insurance companies, care management companies, employers, and government agencies wishing to coordinate medical and mental health care management services. In these positions, he has designed many integrated case management programs and trained case managers and practicing physicians from varied specialties in cross-disciplinary techniques so that they could coordinate care for patients with multimorbidity. Dr. Kathol has over 150 peer-reviewed publications related to the interaction of general medical and mental health disorders, and, with Suzanne Gatteau, has authored a book, Healing Body and Mind: A Critical Issue for Health Care Reform, (2007) which explains how to transition today’s siloed care to integrated care through purchaser, health plan, provider, and patient
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partnerships.
ebecca Perez, RN, BSN, CCM, has experienced firsthand the impact that segregation of physi- cal and behavioral health has on the coordination of care, health service delivery, and patient outcomes during 15 years in acute care nursing and 15 in case management. As a result, Ms. Perez, a resident of St. Louis, Missouri, coauthored the depression chapter of the Case Management Adherence Guidelines (2006), has written numerous patient education articles on case management integration, and has presented nationally on and contributed to the development of integrated case management curricula. She currently serves on the national board of directors for the Case Management Society of America and has been active in her local chapter. Ms. Perez is president and owner of Carative Health Solutions, which provides direct care/case management services and consults to case management professionals on strategies to apply integrated case management principles in their programs. She has been involved in the creation of the integrated case management training curriculum at the Case
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Management Society of America since its inception and is currently an accredited trainer.
anice S. Cohen, PhD, CPsych, is a clinical psychologist at the Children’s Hospital of Eastern On- tario (CHEO), as well as clinical professor in the School of Psychology at the University of Ot- tawa. Throughout her career, Dr. Cohen’s clinical and research activities have focused on children and youth who have complex medical and mental health issues. As clinical head of the Behavioural Neurosciences and Consultation Liaison Team at CHEO, she has championed integrative collaborative health care, most recently through her initiative to develop a multifaceted clinical decision-making tool, the Pediatric INTERMED Complexity Assessment Grid (PIM-CAG), to improve assessment and treatment planning for children and youth with complex health needs. Dr. Cohen is currently princi- pal investigator of a funded research project at CHEO examining the psychometric properties of the PIM-CAG in children and youth with inflammatory bowel diseases. She is a recipient of an Expertise Mobilization Award from the Provincial Centre of Excellence for Child and Youth Mental Health at CHEO in support of her work on the development of the PIM-CAG. Dr. Cohen’s other ongoing re- search projects include a multisite Canadian study investigating knowledge translation strategies in pediatric procedural pain. For over a decade, Dr. Cohen also served as the Director of Training in Psy-
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S chology at CHEO and has received awards from national and international professional bodies for E her contributions to training.
The Integrated
Case Management Manual
Assisting Complex Patients Regain Physical and Mental Health
Supplemental Appendices
Roger G. Kathol, MD Rebecca Perez, RN, BSN, CCM Janice S. Cohen, PhD, CPsych
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New York E
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Contents
APPENDIX A: Stratification and Prioritization of Triggered Complex Case Management Candidates 1
APPENDIX B: Case Management Candidate Induction Templates 5 APPENDIX C: Potential Content for a Case Management Brochure 9 APPENDIX D: Notification Letter to Patient’s Clinician(s) 11 APPENDIX E: Scripted Questions: Integrated Case Management
Assessment for Adults 13
APPENDIX F: Scripted Questions: Integrated Case Management Assessment for Children/Youth 17
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A
APPENDIX
Stratification and Prioritization of Triggered Complex Case Management Candidates*
STRATIFICATION LEVEL DETERMINATION
LEVEL I
· Little impact: Minimal management involvement (e.g. health coaching, wellness programs), such as:
· Education
· Placement assistance
· Anticipated time of involvement: Days or less
· Typical clinical situation:
· Coming out of a high health care cost activity, such as an inpatient stay, with anticipated rapid recovery and little follow-up need
· Minimal interaction of medical and psychiatric illness and/or issues have already been addressed
· Likely IM-CAG score: Below 22
LEVEL II
· Low impact: Brief management involvement (e.g. disease management, disability management), such as:
· Education
· Placement assistance
· Referral to personal nurse or disease management
· Assistance with workplace reentry (Employee Assistance Program [EAP] involvement)
· Assistance with community programs
· Anticipated time of involvement: Days to weeks
· Typical clinical situation:
· Coming out of high health care cost activity, such as inpatient stay, with anticipated persistent need for sup- port to prevent delayed recovery and/or poor long-term outcome
· Likely IM-CAG score: 23 to 29
LEVEL III
· Moderate impact: Standard case management involvement, such as:
· Identification of patient needs in the physical, social, behavioral, and health system domains
· Development of a care plan
· Assistance to the patient in understanding illnesses and health system factors that impede receiving appro- priate care
· Systematically working through the care plan
*Note: “Stratification” of potential candidates for case management is based on a triggering process estimate by the enrollment specialist of a patient’s service use pattern, which suggests persistent or worsening illness, functional impairment, and high health care service use (see Appendix 2).
“Prioritization” of potential candidates stratified at a high level and in serious consideration for case manage-
ment intervention relates to practical considerations about who is most likely to benefit (i.e., improvement poten- S tial, motivation to change, ease of contact, and prior case management outcome). E
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2 The Integrated Case Management Manual
· Anticipated time of involvement: Weeks to months
· Typical clinical situation:
· Inpatient and outpatient persistent service use and probability of further difficulties
· Poorly treated psychiatric comorbidity in the face of serious subacute and/or chronic general medical illness, social challenges, and health system issues
· Poorly treated medical comorbidity in the face of serious subacute and/or chronic psychiatric illness, social challenges, and health system issues
· Likely IM-CAG score: 30 to 35
LEVEL IV
· High impact: Extended case management involvement, as in Level III; however, problems are persistent, com- plex, and multiple with long-term high service use or anticipated risk of high service use, thus longer term case management involvement warranted
· Anticipated time of involvement: Months or longer
· Typical clinical situation:
· Complex, concurrent physical and mental conditions with inpatient and outpatient long-term service use
· Likely IM-CAG score: 36 or…
