Development of a Care Management Curriculum: An Academic-Practice Partner Collaboration

Monday, 18 November 2019: 2:45 PM

Susan Ciurzynski, PhD, RN, PNP
School of Nursing, University of Rochester, Rochester, NY, USA

Care management is a relatively new field that specifically focuses on closing quality gaps and promoting continuity in care delivery across health care settings, as well as caring for people living with multiple chronic conditions who are at risk for poor clinical outcomes. They also work to lower health care costs by reducing unnecessary hospital re-admissions and emergency department visits by providing the access, education and support vital to keeping people healthier longer. Despite the evidence that supports the rationale for care management, the role of a care manager tends to be inconsistently defined and operationalized across the nation’s health care delivery system. As a result, care managers have often needed to develop their roles in response to the care contexts in which they are practicing. These inconsistencies with instituting clear roles/responsibilities and the lack of establishment of a comprehensive, evidence-based curriculum among care management teams provided the impetus for a large healthcare practice to seek the assistance of a local academic institution.

In the spring of 2013, the Dean of a School of Nursing in the western part of New York State, USA awarded a $7500 grant as seed money to launch a Care Management Education program. The Director of the school’s Center for Lifelong Learning established a collaborative partnership with a community-based Director of Care Management to develop a comprehensive curriculum for care managers working for a clinically integrated network of hospitals and physicians. The partnership was immediately viewed as mutually-beneficial as the faculty member had experience as a Nurse Planner for nursing contact hour activities; expertise in the design and presentation of educational offerings using creative, interactive, and innovative methods; and access to a team of Instructional Design experts and costly educational technology. Likewise, the Director of Care Management had experience as a Care Manager/employer of care managers; expertise in the role/responsibilities and curriculum needs of care management teams; and access to a team of interprofessional experts representing leadership, administrative, clinical, care management, data warehouse, and healthcare operations teams.

During the 2013-2014 academic year, the partners developed a content outline, explored options for delivery format, built a small project team of core experts who worked together to develop the curriculum, and completed pilot testing and paperwork for nursing contact hours. Although the initial content outline provided guidance for the project timeline, the final curriculum for the 2014 launch was an iterative process. For example, as content was created on the topic of population health and care management strategies including empanelment and risk stratification, the partners recognized the need to add background content on the topic of the changing healthcare environment and value-based purchasing. Similarly, as content was created on helping patients self-manage their complex medical conditions, the topic was expanded to include the challenges of health literacy and best practices in patient education.

The original 8-module complete online program—which provided care managers and potential care managers with evidence-based strategies for applying the critical functions of care management to real-world clinical practice—launched in January of 2015. A total of 143 participants from the New York State area completed the original curriculum during the first 2 years it was available. During that time, 100% of participants (N=143) rated the course content and delivery as effective, satisfactory, and very useful for new and experienced care managers. Selected quotes from learners included: “Overall the program was very well done and had a nice variety of educational tools. I feel it touched on all the topics necessary for care managers, old and new, to make sure they are well rounded in their positions,” and “It's beneficial to have an educational series from time to time to either bring up new information or topics as health care evolves, or as a refresher for those who have been in the field for many years. We can always take away something new.” Although employers shared their satisfaction with their learners’ needs being met, according to the practice partner, the 2015 version of the curriculum (which was developed in 2013-2014) had soon become outdated as the field of care management continued to explode and evidence-based strategies were being disseminated.

As the contact hour packet was due to expire at the end of 2016, the academic-practice partners once again re-grouped to discuss whether or not to update/re-launch a newer version of the curriculum. In addition to overwhelmingly positive feedback from course participants, healthcare organizations shared their desire to continue to use the online content for new hire orientation as well as to provide experienced care managers with current, evidence-based content directly related to their roles as they were preparing for national certification. The project team was re-established with a re-affirmed commitment from the Dean of the School of Nursing to provide the resources and funding for this mutually-beneficial partnership (creating collaborations with community partners was consistent with the school’s strategic goals).

The updated content was incorporated into the curriculum along with state-of-the-art strategies, examples, and resources that became available during the previous 3 years. The collaborative partnership also expanded as the Director of Care Management’s team of experts grew to meet the expanding needs of the Accountable Care Organization. The expanded content was able to provide content from a variety of interprofessional healthcare colleagues who play crucial roles on care management teams. Consequently, the revised curriculum was targeted to care management teams instead of the previous focus on the care manager alone and continuing education credits were obtained for social workers in addition to nurses.

The revised 10-module complete online program—which definitively describes the three functions of care management and links the scientific basis for each of those functions to real-world applications in clinical practice—was launched in September 2017. A total of 180 participants from across the United States completed the revised curriculum as of December 2018. During that time, 100% of participants (N=180) rated the course content and delivery as effective, satisfactory, and very useful for new and experienced care management teams. Selected quotes from learners included: “This care manager course establishes a great overview of the scope of care management responsibilities, and provides resources to help support and build the multiple practices involved in care management.” “This course was immensely useful to my practice, my personal growth, and also preparation for certification.” “As a certified case manager I believe this course provides an excellent amount of information about working collaboratively with patients. This is a beneficial program whether you are new to care management, want to get an understanding of what a care manager does, or you have been doing care management for a while.” “Content was timely, easy to understand and fit well into the life of a full time working nurse.” Once again, in addition to participant feedback, the practice partner shared that employers were grateful for the easily-accessible, self-paced education that is delivered in an interactive, engaging online delivery format.

A real benefit of this program is that it was created in collaboration with a diverse interprofessional team and is both open and relevant to all of the members of the care team – nurses, care managers, social workers, community workers, and others – who are essential to the success in managing care in a seamless way. Through significant investment in care management and collaboration with providers across the network, this practice partner has helped community providers earn significant gain sharing while achieving improvement in many indicators of clinical quality—including cancer screening rates, hypertension and diabetes control. The mutually-beneficial outcomes described herein are consistent with a recent integrative review wherein authors reported that such relationships are “achievable and measurable through joint planning and collaboration” (Sadeghnezhada, Nabavib, Najafic, Kareshkid, & Esmailye, 2018, p.1).

This program is the result of a lot of intensive research and planning by academic faculty and staff who partnered with experts in this topic’s growing field. The success of this collaboration as well as challenges experienced along the way have clear implications for nursing practice, education, administration, leadership, and patient outcomes. Accordingly, this presentation will share specific details that will assist other clinicians who might consider academic-practice partnerships to address their regionally-identified needs. Participants will walk away with practical tips and suggestions for future collaborations aimed at improving health outcomes.

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