DorlandHealth

Hussein A. Tahan, DNSc, RN, CAN, is the executive director of International Health Services at New York-Presbyterian Hospital in New York, co-author of CMSA’s Core Curriculum for Case Management, and a member of the editorial advisory board of Professional Case Management journal.

Q: From a researcher’s standpoint, would you classify case management as a profession or a specialty practice?

A: I view case management as a specialty practice. A “profession” requires specific knowledge and skill that is almost always acquired in the context of formalized and intensive academic preparation — often long in duration. Examples of a profession are nursing and social work. A “specialty,” on the other hand, is an area of concentration of one’s efforts and responsibilities, usually in a particular field or practice. Specialty tends to be a distinctive branch of the many branches of a profession, is of particular purpose, reflects excellence, and may not require academic preparation.

One can then say that “case management” is a specialty/branch within nursing practice, social work, or other health-related professions. Currently, individuals practice case management only after earning a degree that qualifies them entry into a specific profession, most often after gaining some years of experience in the same profession. Academic preparation for case management is not necessary, although it is preferred.

What role can research play in demonstrating the value of the practice of case management?

Research is essential for legitimizing case management and quantifying its impact on outcomes of health care delivery, both client- and organization-related. It is also important for establishing case managers as focal members of health care teams.

Of the numerous benefits of case management research are: clarity and standardization of the roles and functions of case managers, delineation of knowledge required for effective practice, linking case managers’ functions to safety and other specific health outcomes (i.e., case manager sensitive outcome indicators), promoting case managers as necessary members of health care delivery teams, developing specific health/public policy agendas, and influencing the enactment of particular laws such as the mandatory presence of case managers for care management of the chronically ill and elderly.

How can case managers become more involved with contributing to the body of knowledge in their practice?

Case managers are invaluable in advancing the field. They can contribute to the body of knowledge in many ways, which include: engaging in the conduct of research; sharing their stories and experiences in peer-reviewed journals or magazines; speaking publicly at national or international conferences; mentoring those who are new to case management; volunteering on national case management-related task forces (e.g., National Transitions of Care Coalition) and committees of professional societies (e.g., Case Management Society of America); or participating on editorial advisory/review boards of journals.

Case managers many not be able to be involved in every strategy cited here. One must choose the area(s) most comfortable and contribute accordingly. Having a degree of expertise in one’s contributory area is essential for demonstrating the credibility and reliability of the knowledge shared, even if it were in the form of advice or constructive criticism.

Any additional point you would like to make?

I cannot emphasize enough the importance of “international case managers,” a role that is beginning to develop as a result of “patient migration.” This term describes patients leaving their region or country for health services that are unavailable in one’s region, available but after a lengthy waiting period, of exceptional quality, or less costly and affordable, especially if excluded from their health insurance plan.

Another reason is the surge of “global” insurance plans where an enrollee signs up for care (e.g., elective surgery) in another country known to be less costly (e.g., Singapore). The case manager’s role is similar to what we are used to; however, the context it is executed in is slightly different. For example, the case manager may coordinate utilization review and discharge planning activities by dealing with medical attaches at consulates, personnel of insurance companies outside the U.S., or primary care providers in the patient’s country of origin.