Efficacy of Clinical Case Management in the Military


Name: Frances Anderson

Rank: COL, USA

Organization: Henry M. Jackson Foundation

Performance Site: Dwight David Eisenhower Army Medical Center, Fort Gordon, Augusta, GA; Blanchfield US Army Community Hospital-Ft. Campbell, KY

Year Published: 1995

Abstract Status: Final


Clinical case management, a patient-focused strategy in which one individual coordinates a patient's care, when combined with critical paths, can improve quality of care, decrease length of stay, decrease readmission rates, reduce cost of care, and enhance job satisfaction among hospital staff. This intervention study evaluated the effects of clinical case management at Eisenhower Army Medical Center (EAMC) and Blanchfield U.S. Army Community Hospital (BACH). Patients at EAMC were in the areas of diabetes, cardiology, cardiothoracic, oncology, pulmonary, and vascular surgery; at BACH, they were from the obstetric, medical, surgical, and psychiatric populations. The investigator measured patient satisfaction, nurse-physician communication, work environment and job satisfaction, inpatient length of stay, inpatient acuity, and readmission rate in case-managed populations. The health care team was assessed by the Moos Work Environment Scale, the LaMonica-Oberst Patient Satisfaction Scale, and the ICU Nurse-Physician Questionnaire Communication Subscale. Nurse-physician communication was assessed by the communication subscale from the Shortell ICU Nurse-Physician Questionnaire. Patient satisfaction was assessed using the LaMonica-Oberst Patient Satisfaction Scale. Findings were analyzed by paired t tests and multiple regression.Patients indicated a high degree of satisfaction. No changes occurred in perceptions of the environment. Overall health care team scores were mixed, with some scales below average and others above. Physician-nurse communication was poor. Managerial control was well above average, possibly causing below-average innovation scores. During the study, 291 patients with lung masses were evaluated at EAMC, and 128 were put on critical path. Malignancy was diagnosed in 72%, and lung cancer was staged and reported. Some 128 patients avoided hospitalization, saving $1.5 million in costs.Data were compared on 11 patients before and after case management. Based on standardized costs for various services, their cost of care for the year preceding case management totaled $666,225. After implementation, these patients' costs totaled $231,647, saving $434,578.