Assignment: The Collaborative Model Presentation

Assignment: The Collaborative Model Presentation

Sample Answer for Assignment: The Collaborative Model Presentation Included


As a newly hired case manager in the local hospital, you want to set up a collaborative model of case management. Hospital administration is not sure that they want that type of model. Defend your proposal to administration in a formal paper that contains the following elements:

1. An explanation of the collaborative model

2. The argument for why this is the best model – provide at least three scholarly references to support your argument.

3. Describe the elements of the model: the who, what, where, and when.

4. Include the collaborative relationships that would be needed to support care across the lifespan.

5. The hospital has a strongly embedded electronic health system model. Explain how you will incorporate this model with your case management model.

The paper should be 3 – 5 pages (APA format) not including the title page or reference page responding to the question(s) above. You must have at least 2 scholarly references in addition to the textbook and 2 citations.

A Sample Answer For the Assignment: Assignment: The Collaborative Model Presentation

Title: Assignment: The Collaborative Model Presentation

The primary purpose of case management services is to enable patients and families to meet their comprehensive health needs through advocating for them and coordinating appropriate care. Case management is referred to as the process of planning, coordinating and reviewing the care of an individual (Zander, 2017). Case management nurses provide care both in hospitals and communities. Most of them work closely with social workers to obtain services for individuals who need long term care or home care after hospitalization. Case management is a collaborative process, whereby nurses, physicians, social workers, and a broad range of medical and non-medical experts work together to improve long term care. Additionally, case managers work holistically to ensure that care and discharge plans meet the emotional, social, and physical needs of patients. This paper describes guided care as a case management model in a broad view to enhancing readers’ understanding of the model.

In the Guided Care model for chronic disease care, a specially trained registered nurse is recruited and trained further on chronic disease care. The registered nurse works in collaboration with up to five primary care physicians and others in the case management team to provide integrated care (Struckmann et al., 2018).  In this model, predictive modeling techniques use claims data to determine patients with multiple co-morbidities and are at risk of ‘heavy’ health service use in the coming year. For every patient, the guided care nurse provides several services. For instance, the nurse begins by carrying out two hours of comprehensive assessment at the patient’s home. The assessment included mental status, medications, medical condition, nutrition, exercise, functional ability, caregivers, home safety, and insurance.

Assignment The Collaborative Model Presentation
Assignment: The Collaborative Model Presentation

The nurse and the primary care physician compile a comprehensive care guide to meet the patient’s condition. The nurse and physician discuss the care plan with the patient and the family and modify it further to conform to their preferences. The final result of these discussions is an evidence-based realistic plan of care that addresses medications, physical activity, diet, monitoring, targets, and follow up (Hostetter, Klein, McCarthy, & Hayes, 2016). Based on the care guide, the nurse drafts a patient-friendly My Action Plan which is retained by the patient and placed in a visible place in the house. It reminds the patient when to take medications, diet, physical activity, and when to monitor weight and blood pressure. It also reminds the patient when to see the doctor.

The nurse performs a monitoring phase by reviewing the action plan every month with the patient. Most contacts are made through phone calls; however, the patient can come personally to the hospital. During the monitoring, the nurse checks whether the patients follow all components of the care plan (Malone, Capezuti, & Palmer, 2015). The Guided Care nurse refers the patients to a local chronic disease self-management course which is approximately two hours per week and goes for six weeks. Furthermore, the Guided Care nurse leads a number of classes and support group sessions for about 5 to 10 caregivers. These sessions occur weekly for six weeks. Furthermore, the nurse coordinates various parts of healthcare provided in different settings and helps the patient make the transition between those care settings (Struckmann et al., 2018). In addition to that, the nurse also facilitates the patient’s access to several community services such as transportation services, meals on wheels, and adult day health centers.


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According to Hostetter et al. (2016), the Guided Care Model results in high levels of satisfaction with chronic disease care on the part of the physician, patients, and carers.  The perceived quality of care among patients using this model is better compared to patients

receiving usual care. Vermunt, Harmsen,  Westert,  Rikkert, and Faber, (2017) assert that the Guided Care model aims at improving health outcomes and reducing spending by better managing care for patients with multiple chronic conditions. This model was created by Johns Hopkins University researchers in the year 2001 and got licensed to healthcare systems. According to Malone et al. (2015), visiting patients in their homes and building relationships over time enables the case managers to determine personnel and financial problems that may impede patient health. Through this patients are cared for, beyond the medical realm, to enable them to access community services.

The Elements of the Model (Who, What, Where, And When)

Who: this model will I identify patients with multiple co-morbidities who are at risk of ‘heavy’ health service use in the coming year. This group of patients is vulnerable to acquiring even more disease, hence, they need a case management model to improve their status. Each guided care nurse should have a maximum of 50 patients (Vermunt et al., 2017). What: this model entails eight parts such as assessment, creation of care plan, and promotion of patient management, monitoring, coaching, education and support, coordination of transition between providers and care settings, and accessing community services. Where: the care plan happens at the patient’s home, but may be referred to a hospital if the condition gets worse. When: the time frame is open-ended, it can happen until the patient’s condition has improved.

Collaborative Relationships

Guided Care model requires a very strong collaborative relationship for it to be successful. The case management team must collaborate to develop a care guide that suits the patient’s condition. The care plan must be discussed openly between the nurses, the physician, the patient, and family members. In this collaborative relationship, the nurse must provide a summary of the patient’s condition to other providers (Hostetter et al., 2016).  In order to ensure that the process goes well, there must be an understanding between the providers themselves as well as between the providers, the patient, and the family. The relationship between the providers must be based on respect, trust, and commitment. Every case management member must have active listening skills, flexibility, and commitment to follow through the care plan.

How to Incorporate Electronic Health System into the Case Management Model

The electronic health system is an integral part of the Guided Care model. For instance, a secure web-based electronic health record (EHR) can be used to alert the nurse on days when he/she is supposed to perform monitoring services. The system also alerts the nurse regarding drug interactions, appointments, and best practices (Hostetter et al., 2016). Furthermore, information about previous medications, illnesses, and others is accessed from the electronic health system. The results of the assessment, information about care plan, and patient’s progress are recorded in the EHR system. Therefore, the electronic health system can be successfully integrated into this care model to ensure quality patient outcomes.

Assignment: The Collaborative Model Presentation Conclusion

Case management is referred to as the process of planning, coordinating and reviewing the care of an individual. Guided Care model was created by Johns Hopkins University researchers in the year 2001 and licensed to healthcare systems. It aims at improving health outcomes and reducing spending by better managing care for patients with multiple chronic conditions.


Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource