CARE AND COST EFFECTIVENESS OF THE CLINICAL CARE COORDINATOR/PATIENT CARE ASSOCIATE NURSING CASE MANAGEMENT MODEL (CLINICAL CARE COORDINATOR, PATIENT CARE ASSOCIATE).
Contributors: University of California, San Francisco.
Published: 1992
Number of pages: 206
Subjects: Health Sciences, Nursing.; Health Sciences, Health Care Management.
Description: This study examined the impact of a nursing case management model on variables related to the process of nursing care delivery and costs of care. Pre-case management, charge nurses, RNs, and LVNs performed total patient care without clerical support. The model designed for the study restructured the charge nurse role to that of an expanded practitioner called a Clinical Care Coordinator (CCC). CCCs were paired with nurse extenders called Patient Care Associates (PCAs) who were cross-trained clerks and nurses aides. CCCs were operationally accountable for unit activities, collaborative supervision of RNs and LVNs performing total patient care and overall management of a caseload of patients. PCAs performed clerical and clinical activities as assigned by CCCs. Case management was defined as a case method of assignment in which CCCs are accountable for achievement of designated patient care outcomes for a caseload of patients across an episode of illness, transcending unit/setting boundaries.

The study was carried out on a 26-bed medical unit in a community hospital and involved analysis of data collected pre-post implementation of the CCC/PCA model. Dependent variables used existing work sampling, direct care sampling, nursing risk management, home health referral, and costing data from the study site. Descriptive data were analyzed using chi-square statistics.

Study results demonstrated that the CCC/PCA model was care effective. On day shift, CCCs spent significantly more time in direct care activities and significantly less time on indirect care clerical and unit-related activities. On evenings, CCCs spent significantly more time in communication on behalf of the patient. Home health referrals increased and nursing risk management events declined but not significantly. Direct care sampling revealed that the percentage of direct care RN time received by patients increased significantly. On evenings, significantly more RN time was spent communicating with patients. Significantly less time was spent in observational rounds. The CCC/PCA model was more cost effective in terms of total costs/patient day, labor costs/patient day, labor costs/unit of workload, and production inefficiency costs which annualize the dollar cost of having RNs perform non-nursing activities.
Notes: Source: Dissertation Abstracts International, Volume: 53-07, Section: B, page: 3401.

Thesis (D.N.S.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1992.

School code: 0034.