Learning Objective #1: Describe the implementation of evidence-based practice in case management using the ACE Star Model

Learning Objective #2: Discuss the effects of evidence-based practice on outcomes related to fall management of home bound elders and caregiver stress of their primary caregivers

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Case Management has a pivotal role in coordinating care services to home-dwelling elders. However, there exists lack of standardized management protocols for most common diagnoses affecting this group. A 65-member university-based case management team and EBP task-force sought to provide excellent services and "set the bar" for best practices. Systematic caseload review revealed high risk, high volume, and problem prone conditions with falls highest in risk. High volume diagnoses were hypertension, diabetes, osteoarthritis, cardiovascular disease, and chronic lung disorders. Problem prone areas were caregiver burnout and stress, loss through discharge to a nursing home, and depression. The ACE Star Model of Evidence-Based Practice (EBP) approach was used to address 2 of these conditions: Falls and stress-related caregiver burden. Nationally approved fall prevention guidelines from systematic searches were modified or adapted for elders at home. Guidelines were shared with case managers, patients, and family members. Heightening awareness of fall hazards and using checklists for periodic home checks were priority guideline items. Improving mobility and balance of many elderly patients was also found to be a reasonable goal. Established literature on reducing caregiver burden is complex, but offered insight into using community resources for caregiver respite. Along with raising awareness of potential for fatigue, stress, and burnout, caregiver participation in hobby activity, support groups and daycare facilities is urged. Follow-up evaluation of EBP guidelines is positive. Incident reports and empirical data are evaluation measures for falls. The "Get up and Go Test" gauges elder mobility. Caregiver feedback and records of premature discharge are evaluation tools of caregiver support success. Data collection continues to determine long-term effects of the EBP approach, but 2 years of excellent response attest to benefits of standardized management of these key problem areas. Meanwhile, the team gathers evidence to develop EBP case-management approaches for remaining high volume diagnoses.