Hospital- v. Community-Based Care Model


Hospital-based and community-based care models facilitate effective care delivery for patients at the hospital level and community level. Adoption of these models ensures that both the patient and health care provider is satisfied with the management of individual health care concerns at the hospital as well as in the community (Guo, Biegel, Johnsen, & Dyches, 2001). Triad team-based model of care is among the effectively implemented hospital-based care model for care delivery, on the other hand, the identified community-based model is the clinically based management model.

Comparison of the models

Triad team-based model

This hospital-based model of care delivery has effectively integrated social workers and case managers for the specific in-patient population. According to Dossey and Keegan (2012), the key major focus and emphasis of this model is care coordination, planning for discharge, and readmissions. The key major participants in this model are nurse case managers, social workers, and utilization review nurses. In the team, each of them has their specific role in care delivery. The nurse case managers take care of medically complex patients, plan for the discharge of medically complex patients, hospital resource management, and interdisciplinary rounds.

Social workers carry out psychological assessments, patient’s financial assessments, adoption, crisis interventions, handle abuse cases, and any other concerns of the patients (Dossey & Keegan, 2012). Utilization review nurses engage in the medical necessity of admissions, ensure that physician orders are spelled, handle clinical reviews, Medicare Claim reviews, appeals, and retrospective reviews. Notably, the nurse case managers and social workers have a high level of collaboration and effective communication on how they coordinate care delivery to the patients. This model has an effective discharge planning mechanism attributed to proper collaboration and communication with home health agencies and community resources.

Clinical Care Management Model

This community-based care model uses clinicians as case managers, unlike the Triad team-based model which uses nurses as case managers in the provision of direct care service at the community level. Case managers in this model are not just coordinators, patient support staff, or care service brokers (Dossey & Keegan 2012). Clinical case managers focus on personal involvement, clinical acumen, and the adoption of environmental interventions directed to improving and maintaining the physical and social environment of the patient. This community-based model of care entails patient interaction and engagement, medical assessment, discharge planning, stakeholder consultation, crisis interventions, and broad collaborations with medical experts from various departments.

Impact on Nursing Care

The two underlying models when effectively utilized in hospital-based care and community-based care have a positive impact on both qualitative and quantitative improvement of nursing care. The models facilitate effective and efficient use of hospital and community care resources thus minimizing nursing care costs significantly. DiCenso, Guyatt, and Ciliska (2005) provide that these models play a significant role in the improvement of nursing care in the hospital and community-based nursing care centers. It has also resulted in increased patient satisfaction with the provision of nursing care services.

Integration of these models has notably increased coordination, collaboration, and effective communication between care managers, caregivers, social workers, patients’ families, and social support agencies thus improving the quality of nursing care in hospitals and other nursing care providers (DiCenso et al, 2005). Implementation of the Triad team-based model and clinical care management model improves the performance of nursing care-providing organizations. In addition, effective utilization significantly reduces nursing care costs.


Guo, S., Biegel, D. E., Johnsen, J. A., & Dyches, H. (2001). Assessing the impact of community- based mobile crisis services on preventing hospitalization. Psychiatric Services52(2): 223-8.

DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis, MO: Elsevier Mosby.

Dossey, B. M., & Keegan, L. (2012). Holistic nursing. Burlington, MA: Jones & Bartlett Publishers.