Abstract

Providers and insurers have utilized nursing case management to meet the demand for high quality, cost effective health care. Case management is designed to insure that individuals receive quality health care in a timely manner and in an appropriate setting. While case management has been most widely used in hospital settings or for catastrophic injury, disease management is the next step in coordinating care for individuals with chronic conditions. Disease management focuses on individual needs in all health care settings including preventative strategies. The health care coordination concepts used in disease management enable the nurse to work closely with individuals in anticipating their needs and securing the most appropriate care. This project is a collaborative effort between case managers representing the state of Indiana and nurse educators at the University of Southern Indiana. This proposal is to request funding to develop Nursing 484: Health Care Outcomes: Integrating Disease Management and Nursing Case Management as a distance education offering through the Internet with scheduled IHETS class sessions every four weeks. Nurse participants may select to take this offering for college credit (3 hours) or continuing education (45 hours). Total projected expenses are $14,350 with $7,780 coming from the University of Southern Indiana. A grant of $6,570 is requested from IHETS/IPSE Course Development Grant Program.

Need for the Program

In recent years, the growing cost of providing health care has spurred the growth of programs designed to provide high quality yet cost effective services. Case management focuses on the 3-5% of the population that is responsible for 60-70% of the expenditures in a health plan. Case management is a personalized process aimed at identifying high-risk or high-cost patients. The nurse case manager is responsible to coordinate care, design treatment programs to improve quality and efficacy of care, control costs, and manage patient care to insure the optimal outcome. Disease management further extends the concept of case management. Disease management targets groups of individuals with specific diagnoses that have evidence of being costly and that will be significantly improved (cost and quality) with earlier intervention, coordination among service providers, and educational programs. Diseases that have been targeted include asthma, diabetes, high-risk pregnancy, cardiovascular, and chronic neuromuscular. This course is intended to provide cutting edge information to RNs about health care delivery, case management and disease management necessary to effectively provide cost effective, quality patient care in this managed care environment.

The University of Southern Indiana School of Nursing and Health Professions has worked closely with professionals in our community to provide educational activities related to case management and disease management. The Case Management '98 conference in June had approximately 200 attendees from southwestern Indiana. In reviewing the evaluation data from this conference as well as past case management conferences, the participants have indicated a need for this type of continuing education/course offering on integrating disease management and case management concepts with health care outcomes. The members of the planning committee have reported that collaborative efforts such as this proposed offering have not been identified elsewhere in the state of Indiana.

To meet the work force need of additional baccalaureate prepared nurses and to meet the professional development needs of these nurses, the University of Southern Indiana School of Nursing and Health Professions offers an Internet based RN-BSN completion program. Additionally, USI has been committed to providing continuing education courses to nurses interested in additional skills and knowledge but are not enrolled in degree programs. Many nurses do not have easy access to educational opportunities. Furthermore, most nurses who are interested in advancing their professional development are employed full time in their field with schedules that require flexibility. Because of their work and family responsibilities, these nurses are ideally suited for a learning offering as proposed in this grant. This type of distance education offering will provide interested nurses the opportunity to further their education and to increase their knowledge and skills related to these managed care concepts. Our estimate of enrollment is a combined total of 20 participants in each of the Fall 1999 and Spring 2000 semesters.

The purpose of this proposal is to request funding to develop Nursing 484 via distance technology. The funding of this proposal will allow the faculty and staff to integrate our current success in providing case management offerings with distance education delivery to provide additional learning opportunities to a wide range of nursing professionals throughout the state of Indiana.

Institution's Commitment to Project and Capacity to Complete

The School of Nursing and Health Professions faculty and staff are experienced in the development and implementation of computer mediated instruction courses. Seven nursing courses in the RN-BSN completion program have been redesigned for Internet delivery with scheduled IHETS class meetings. The School of Nursing and Health Professions has also developed a national Internet based Anticoagulation Certificate Program for health care providers interested in establishing anticoagulant clinics. This experience in developing these courses or program for distance education delivery will be used during the development of this course as a combined credit hour course and continuing education offering. The success of these distance learning courses and programs cited above demonstrate that the University of Southern Indiana staff and faculty have the expertise to support these endeavors. A letter of support for this project from the Dean of the School of Nursing and Health Professions is included in the appendix of this proposal. This letter supports the need for this distance education offering and identifies how the funds requested will be used to encourage other combined course and continuing education offerings.

Course Development Plan

Instructional Design Plan

The primary method of course delivery will be the Internet supplemented with scheduled IHETS sessions. The Internet is useful in this type of offering because the participants are provided with the flexibility to learn within their own schedule. Another use of the Internet is the availability of additional information that expands the course content beyond the traditional instructional material. A Webboard with conferencing software will also be provided for students to complete the assignments and discuss course content on a weekly basis. E-mail will be used for individual communication between faculty and participants. The use of IHETS sessions every four weeks during the offering will create opportunities for the participants to interact with each other and the instructor. Results of previous evaluation of courses using multiple types of content delivery have indicated that nurses value the learning independence of the Internet. They also appreciate the opportunities to personally interact with peers and faculty. Meeting every four weeks during the offering will provide the participants with a combination of technology

supported instruction and classroom interaction that encourages successful completion by the nurse participants.

Weekly learning modules will be developed that will focus on specific course concepts. Each module will consist of learning objectives, assignments, links to appropriate Internet sites, study questions and/or case studies to direct the participants' learning and to apply the content. Participants will be encouraged to share their thoughts, questions, and issues through the use of the Internet conferences developed for this offering.

Course Evaluation Plan

The faculty in the School of Nursing and Health Professions developed a formative evaluation tool that will be sent to the participants midway through the offering. The tool requests participant feedback on the quality of instruction, the most useful learning activities, the type of distance education modality most helpful to them, and any suggestions to improve the offering. Continuing education participants will also receive a modified formative evaluation tool that addresses the same issues from a continuing education perspective.

The tool will be administered midway through the offering. Results of the evaluation may support faculty modifying the remainder of the offering if needed. Both tools will also be administered at the end of the offering as a part of the final evaluation.

Faculty members are committed to sharing the development and implementation process of this offering as well as the evaluation results with other faculty.

Plans for Peer Review and Interinstitutional Acceptance

A planning committee has been established that represents case managers from the state of Indiana, USI nursing faculty, and the continuing education coordinator for the School of Nursing and Health Professions. This committee will be instrumental in the development of the modules. The strength of this committee is the collaborative effort of the members of the committee. Nursing faculty bring expertise in the development of teaching strategies for the modules; case managers bring the expertise of being in the field with identification of relevant content in case management and disease management. The Continuing Education Coordinator assures that the course will meet the continuing education requirements as prescribed by the Indiana State Nurses Association.

The case managers on the committee have an available network throughout the state of Indiana. One individual on the committee is owner of an organization with five sites throughout the state of Indiana. Networking through these five sites provides excellent opportunities to identify the target audience as well as relevant case management and disease management topics throughout the state as well as the southwestern region of Indiana. Other case managers on the committee are involved in case management/disease management organizations at the local, state, and national level.

Timeline

January - May, 1999	Development of the course and Web pages
June 1999	Faculty attendance at conference, Interactive Distance Learning Workshops sponsored by the Indiana University Center for Excellence in Education, Bloomington
July, 1999	Completion of Web pages
January -August, 1999	Marketing through ICN catalog, USI schedule, nursing continuing education brochure, Internet site, etc.
August 1-10, 1999	Final review by Planning Committee
August 25- 31, 1999	Technology orientation offered
August 31, 1999	Classes begin at USI
October, 1999	Midterm evaluation for both the course and continuing education offering
December, 1999	Course completed with summative evaluation

Key Personnel

Ann White, RN,MSN,MBA,CNA - Program Director of the Undergraduate Nursing Program. Ms. White and Ms Kuric will share overall responsibilities of coordination for the course and continuing education offering. Ms. White has developed both a graduate and undergraduate nursing course for Internet delivery, both courses had limited use of IHETS. A copy of her C.V. is included in the Appendix.

Judi Kuric, RN,MSN,CRRN,CNRN,CCRN – Special Projects Director. Ms. Kuric will share overall responsibilities with Ms. White. Ms. Kuric has developed several nursing and health profession courses for the Internet with limited use of IHETS. A copy of her C.V. is included in the Appendix.

Charles Anstett - Computer and Internet Services Coordinator. Experienced with Web page design. He will develop course Web pages for Internet and provide technical support to students and faculty.

Terry Martin - Secretary for the Undergraduate Nursing Program. She will provide secretarial and course editing support

Peggy MacMillan - Secretary for Continuing and Distance Education in the School of Nursing and Health Professions. She will provide assistance with the coordination of the awarding of continuing education hours and Internet support.

Planning Committee

Lisa Gish,RN,CRRN,CCM - Executive Director of the Tri-State Business Group on Health, Evansville, IN; President of the Case Management Network.

Peggy Graul, RN,MSN - Coordinator of Continuing Education, University of Southern Indiana.

Tammy Hirsch,RN,MSN,CRRN,CNRN - Coordinator of Case Management Services, Deaconess Hospital, Evansville, IN

Judi Kuric, RN,MSN,CRRN,CNRN,CCRN – Director of Wellness, University of Southern Indiana.

Susan Mueller, RN, CRRN,CCM - Case Manager, Evansville Cancer Center, Evansville, IN

Ann Roberts,RN,CCM - President, Individualized Care Management, Inc. Lafayette, IN; five sites throughout the state of Indiana (Lafayette, Evansville, Anderson, Warsaw, Indianapolis)

Kay Rose,RN,CCM - Care Manager Team Leader, Individualized Care Management, Inc., Evansville, IN

Ann White,MSN,MBA,CNA - Undergraduate Nursing Coordinator, University of Southern Indiana.

 

Ann H. White

 

Education

Georgia State University, Atlanta, Ga., Doctoral Candidate - Nursing Education

Graduate with Ph.D., December 1998

West Virginia Wesleyan College, MBA, 1990

University of Cincinnati, MSN, 1981

University of Iowa, BSN, 1979

Experience

Assistant Professor of Nursing 1990-Present

Undergraduate Nursing Coordinator

University of Southern Indiana Nursing Program

Developed and implemented two nursing courses (one undergraduate and one graduate) for distance education. Have used two way audio and visual (PictureTel), one way audio and visual (IHETS) and Internet. Responsible for the implementation and revision of the undergraduate nursing curriculum.

Licensure and Certification

Registered Nurse - Indiana and Kentucky

American Nurses Association

Nursing Administration #083083 1985 to 2000

Professional Membership

Case Management Society of America 1997 to present

Tri-State Case Manager Network 1995 to present

Sigma Theta Tau 1977 to present

American Nurses Association 1998 to present

National League for Nursing 1981 to present

American Organization of Nurse Executives 1982 to present

Midwest Nursing Research Society 1992 to present

American College of Healthcare Executives 1993 to present

Advisory Boards

National Online Advisory Board of the Case Management Community; Internet site for the Case Management Network.

Judi Kuric MSN RN CRRN-A CNRN

Academic Preparation

Wayne State University, Detroit Michigan. Master of Science in Nursing, 1990. Major: Nursing. Minor: Education. Cognate: Physiology.

Indiana University, Indianapolis, Indiana. Bachelor of Science in Nursing, 1983. Major: Nursing. Minor: Psychology.

Licensure

Indiana Registered Nurse License

Certification

Critical Care Registered Nurse (CCRN), July 1986 to July 1998.

Certified Rehabilitation Registered Nurse (CRRN), December 1987 to 2002.

Certified Neuroscience Registered Nurse (CNRN), November 1994 to 1999.

Certified Rehabilitation Registered Nurse - Advanced (CRRN-A) March 1998 to present.

Professional Experience

Neuro Rehab Solution, Clinical Nurse Specialist / President , 1988 to present.

*Comprehensive patient and family care including case management services

*Authored education guidelines / materials, standards of professional practice,

and guidelines for care.

HealthSouth Tri State Rehab Hospital, Clinical Nurse Specialist, 1990 to present.

*Collaboration on care for patients with spinal cord injuries and their families

*Manager of spinal cord injury outpatient clinic

*Educational activities for facility staff, patients, and families

*Continuing education program planning and evaluation

University of Southern Indiana (Evansville), School of Nursing and Health Professions.

Director of Wellness and Special Projects September 1996 to present.

*Coordinate classes and programs on health promotion and wellness

*Manage Health Promotion Resource Center

*Developed and implemented curriculum for a Certificate in Health Promotion and Worksite Wellness

*Developed and implement curriculum for credit courses on Health Promotion and Worksite Wellness

*Obtained grant funding for development and implementation of certificate program

*Developing health promotion certificate course for Internet and multimedia delivery

Grants

Foundation for Community Health $50,000 award to develop a certificate program in health promotion and a health promotion resource center. Awarded November 1995.

Center for Teaching Learning Excellence, University of Southern Indiana $2000 award for the conversion of HP305 Health Promotion and Worksite Wellness to a distance delivery format. Awarded June 1998.