Health Maintenance Organization Case Study

Practice context:
Health Maintenance Organization (HMO) is a company that provides health care services for a fee often monthly, bi-annually, or annually. It is also known as medical insurance, and acts as an intermediary between individuals, organizations, and health care professionals (including doctors, nurses, and hospitals). Health Maintenance Organizations is managed by medical doctors and nurses who work as case managers (HealthCare.gov, 2017). Case Management is a collective process that involves assessing, planning, facilitating, care coordinating, evaluating and advocating for participating clients and services that meets the clients’ extensive health needs through communications and use of available resources to ensure quality yet
The major attribute of the SCD is chronic haemolytic anaemia and vaso-occlusion. Although it is a blood disease, SCD affects the whole body with the pathophysiology beginning at a young age among the patients. Therefore, the Paediatricians and family practitioners have a critical role that requires managing the pain, which is the hallmark of this disease in children (Quinn, 2013).
Generally, SCD is a result of defective haemoglobin making the red-blood cells stiffed, forming a “sickle” of a crescent shape rather than flexible and round. These sickled cells consequently resulting in vascular occlusions having both acute and chronic complications such as painful episodes of attacks on different organs in the body (Graumlich et al., 2010). Therefore, addressing all these facets with major goals of managing of the vaso-occlusive crisis, managing the chronic pain syndromes, managing of chronic haemolytic anaemia, preventing, and treating infections, managing the complications and the various organ damage syndromes associated with the disease, preventing stroke, detecting, and treating of pulmonary hypertension become principal concern of health care providers (Maakaron and Taher,
Overview of methods:
An academic database search was conducted which includes PubMed, Google scholar, NIH, ASH-blood, University of derby library with the use of key words (Table 1). All articles considered were articles published within the last 10 years (2007-2017). Papers that were considered relevant were papers that addressed pain management (at home and in the hospital) in children with sickle cell disease.
Preferred Reporting Items for Systematic Reviews and Meta-analyses’ (PRISMA) was used to analyze the literatures from the first and subsequent searches. The search was not limited to any country however, only articles published in English language were included.
In this review, publication with clear-cut search methodology and that provided evidence in a systematic order were included. Articles based on expert opinion with non-researchable evidence or organisational experience was also not included. Table 2 shows the inclusion and exclusion criteria based on the PICO question developed. Table 3 illustrates the appraisal of included publications based on quality using strength and quality scores (Newhouse et al.,