Q&A: Hospital case management models

Q: Which hospital case management model is best for your facility?

A: Each model is dependent upon the healthcare provider, staffing, and the population served. As hospital CM services and programs have expanded, we very basically see CM falling into what is now referred to as “dyad” or “triad” models. At hospitals that use the dyad model, we see primarily an SW and nurse, each assuming specific roles and duties. Generally, this has the nurse assuming responsibility for the utilization management functions and discharge planning, while the SW assumes responsibility for any psychosocial elements and therapeutic inventions needed for patients. With the advent of emphasis placed on the business aspect and the role CM has, we now are seeing the advent of what is termed the triad model. This model basically uses three professional disciplines. This added role often focuses on such activities as clinical documentation improvement or denial management, all with a business focus to assist a hospital with protection of financial interests. Hospitals rely on dyad and triad models for staffing, roles, and deployment. Some use one model only, but others use both in various departments (e.g., dyad in the ED, triad in nursing units).

Dyad model
A nurse has the following CM responsibilities:

• Coordination of care, discharge planning, transition planning
• Appropriateness of admissions reviews, bed management, concurrent utilization management reviews, and clinical documentation improvement that involves collaboration with physicians to improve documentation quality and completeness and billing accuracy of billing
• An SW has the following CM responsibilities:
• Psychosocial assessments and interventions
• Assistance for patients classified as high risk or with complex discharge planning needs

Triad model
The triad model adds a third staff member to the team with CM responsibilities assigned as follows:

• A nurse who performs coordination of care, discharge planning, transition planning
• An SW who provides psychosocial assessments and assistance with high-risk discharges
• A nurse who performs utilization review and/or clinical documentation improvement activities

For more information, see The Hospital Case Management Orientation Manual.

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