It was the 1980s, my first day as a medical-surgical case manager, and I was already wondering what I had gotten into. This floor was infamous: nurses went home "sick" before being floated "to that unit," doctors requested that their patients go elsewhere, and at least three patients had "lived" there for between 65 and 74 days. Case managers, utilization managers, and FBI agents were all synonymous in the eyes of physicians; we snooped and told physicians what to do (their words). To top it off, some of the most colorful patients in the city (I was sure) were on this unit.

There was little in the way of knowledge or tools that one could use to do the job. In fact, there was little definition of what the job was, and certainly no framework. Although I learned many things the "hard way," gradually something started to change. As I was traveling down the case management path (sometimes stepping into quicksand-sometimes stepping into other substances), case managers across the nation were pooling their knowledge. In grassroots fashion, chaos took form through the entrepreneurial efforts of case managers-turned-teachers; and case management groups, whose mission was to move this fledgling profession forward, evolved.

Something else was brewing in the 1980s. Healthcare professionals needed a structured decision-making process that would give both professionals and patients the ability to choose the best available interventions for the outcomes they were seeking. A new term, "evidence-based medicine," was coined by clinicians and epidemiologists at McMaster University in Canada in 1988 (Donald, 2002). Donald goes on to state (p. 2):

Psychologically, evidence-based medicine works by enabling people to "see" the difference between alternative decisions that would be hard to ascertain otherwise. Most best-practice decisions in healthcare hinge on partial probabilities of things working, because most interventions that work have marginal effects, some of the time, in some people. When tested against placebo, very few interventions work 100% of the time or even anything approaching it. Yet, as human creatures, we are not terribly good at guessing partial probabilities intuitively. Rather, we tend toward thinking that things either work or they do not, without a clear sense of how likely these outcomes really are in a particular individual. At a broader level, evidence-based medicine works by providing a safe framework in which different parties can make tough decisions, because their concerns can be considered according to a fair and scientifically rigorous process.

Why, then, did these two initiatives emerge in the 1980s? For case management, the complexity of healthcare and need for patient advocacy present as good reasons. For evidence-based studies, the advent of computers allowed for large databases with which to distinguish "what works" from "maybe not." A second leveler was the Internet, which streamlined the ability to do robust literature searches at a never-before-imagined speed.

And now the two are merging: case management and evidence-based practice (which is supported by evidence-based medicine). For the past several years, I have noticed more research-based manuscripts coming to this journal; I have also observed that, as the years went by, earlier manuscripts were used as stepping stones for later studies. Case managers are seeking a clearer framework, building on knowledge of the past, and asking questions for the future. These questions, in turn, may become the hypothesis of future case management studies.

Evidence-based guidelines are becoming essential tools in the practice of case management. They serve as that valued resource that allows the individual case manager to be proactive in planning, educating the patient and the multidisciplinary team, as well as to anticipate transition needs and scheduling. Utilizing these tools, help the case manager in facilitating quality-focused and timely medical services for the consumer, as well as actively participating in quality initiatives across all of their work settings.

But the change for the profession of case management does not stop there. Starting in January 2007 the Case Management Society of America (CMSA), the premier organization for practicing case managers, is adding even more resources to its already impressive gold mine of information (go to http://www.cmsa.org). Members will now receive two official publications on alternative months:

* Professional Case Management: The Leader in Evidence-Base Practice (PCM), a progressive, peer-reviewed journal that crosses all case management settings (published bimonthly by Lippincott Williams & Wilkins), and

* Case in Point (CIP), a professional lifestyle bimonthly magazine published by Dorland Healthcare Information with Anne Llewellyn, editor-in-chief, at the helm.

By alternating these very different bimonthly magazines, case managers will receive both evidence-based research information through the PCM, and the professional and lifestyle information needed through the CIP; together, these will provide a fuller scope of resources for all levels of case management experience. It is our hope and intent to build on this powerful triad synergy (CMSA, PCM, and CIP), one which will strengthen in the coming years.

Effective, efficient management that is based on truth will make our jobs easier; and it surely trumps the "fly by the seat of our pants" method of the early years. Experienced case managers instinctively make tough decisions on a daily basis; however, we must continue searching and researching, because, as Bertrand Russell has eloquently stated, "Insight, untested and unsupported, is an insufficient guarantee of truth." We ask you, the case managers, to help pose the questions, both for future journal issues and for future research. In this issue, there is an "Ask the Expert" inquiry form (on page 51) for legal questions. And we seek your comments, questions, and concerns. E-mail: [email protected]

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