Professional Case Management Essay

Professional Case Management Essay

The Joint Commission on Accreditation of Healthcare Organization’s has purposed to ensure continuous improvement in the quality and safety of the care that the public receives by providing accreditation of healthcare and other interrelated services which support good health outcomes. Following the implementation of the ACA, a lot of research has been funded by the CMS to ensure a significant reduction in hospital readmissions for the purpose of improving quality and safety (Center for Medicare and Medicaid Services, 2012). The Institute of Medicine has also prioritized hospital readmissions as an integral area for research and an indicator of efficiency and quality of care. A lot of emphasis has been placed on this goal through the declaration that hospitals will no longer receive funding from the CMS unless they receive full accreditation from the TJC (Hines, Yu & Randall, 2010). This reveals the common interest among individual hospitals and governing bodies to prevent readmissions especially among patients hospitalized with heart failure. Professional Case Management Essay


            Patients with heart failure have very complex needs which need a multidisciplinary team approach in management to realize good health outcomes. Instead, a major challenge that is still being faced is in the transitioning of care from one level to another which brings about safety risks (Amin et al., 2014). Besides, independent practice among providers often makes it difficult for nurses to ensure that patient’s problems are well addressed, the right medications are prescribed and administered and the right services are provided. Such episodic and fragmented care is what contributes to duplication of services, medical errors and poor-quality clinical outcomes (Ramanathan et al., 2014).  By identifying these gaps in care, the organization continues to emphasize on the need to support the formation of ACOs, continuous education of nurses and providing patients with the necessary support to increase compliance with the requirements of the TJC and CMS (Thornlow & Merwin, 2009).


Amin, A.N., Hofmann, H., Owen, M.M. Tran, H., Tucker, S & Kaplan, S.H. (2014). Reduce readmissions with service-based care managementProfessional Case Management, 19(6), 255-262.

Center for Medicare and Medicaid Services (CMS) (2012) Readmission’s reduction program.

Hines, P., Yu, K., & Randall, M. (2010). Preventing heart failure readmissions: Is your organization prepared? Nursing Economic$, 28(2), 74-86.

Ramanathan, R., Leavell, P., Wolfe, L.G. & Duane, T.M. (2014). Agency for healthcare research and quality patient safety indicators and mortality in surgical patients. The American Surgeon, 80, 801-804.

Thornlow, D.K. & Merwin, E. (2009). Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes. Health Care Management Review, 34(3), 261-272.

Professional Case Management Essay


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