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Case management has gone from episodic, to coordinating central arenas, to fragmentation, and back again. We must now-at least for complex, selected patients-look at a new (or old) method of case management. This column talks abou...
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Case management has gone from episodic, to coordinating central arenas, to fragmentation, and back again. We must now-at least for complex, selected patients-look at a new (or old) method of case management. This column talks about traditional case management, use of an "alpha" case manager, and the "attending" case manager.
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The purpose of this study is to identify issues of case management (CM) interventions in the United States in recent studies and to identify implications for future research into CM. This study was guided by the following framewor...
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The purpose of this study is to identify issues of case management (CM) interventions in the United States in recent studies and to identify implications for future research into CM. This study was guided by the following framework for a scoping review. Multiple electronic databases were searched to identify studies published between 2007 and 2016 in the United States and related to nursing CM. Five weaknesses were identified: no clear and consistent definition of CM, lack of theoretical frameworks, lack of standard guidelines in CM practice, lack of precise CM dosage and of process measures, and limited reports of explicit role of nurse case managers and role confusion by nurses. Three strengths were also identified. More rigorous and continuous efforts to develop theoretical frameworks and evaluation tools, as well as clear definitions and precise role descriptions, are required for future research and practice into CM.
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PURPOSE/OBJECTIVES: The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a ...
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PURPOSE/OBJECTIVES: The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. PRIMARY PRACTICE SETTING(S): As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. FINDINGS/CONCLUSIONS: Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.
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Background: Home care services are increasing across Canada and in other developed nations. There has been increased pressure on home care programs to not only accept more clients more rapidly but also work more efficiently. Case ...
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Background: Home care services are increasing across Canada and in other developed nations. There has been increased pressure on home care programs to not only accept more clients more rapidly but also work more efficiently. Case management is an approach through which clients access and receive home care. With both rising numbers of clients and growing complexity among them, case managers' work and workload are also increasing. The demands on case managers and expansion in caseloads are happening without an increase in resources or funding. With case manager work increasing steadily, an understanding of the factors that influence their work and workload is vital. Purpose: The purpose of this study was to explore what factors influence case managers' work and workload. Methods: This study used an ethnographic approach. It took place in Alberta, Canada, in 3 home care offices in urban and suburban geographic areas. Purposive sampling was used, and participants included 28 home care case managers with predominantly long-term clients (>3 months on home care), 3 site managers, and 1 project lead. Data collection methods included semistructured interviews, nonparticipant observation, participant joumaling, and focus groups. Results: Case manager works were portrayed in 2 key ways: the number and type of tasks a case manager was required to complete and the amount of time and energy needed to complete a task. The factors that influence case manager work and workload fall into 3 overarching categories: structural, operational, or individual factors. Discussion: The 3 overarching categories, as well as interactions between various factors, contribute to what is known about case managers' work and workload. Participants found it difficult to discuss the factors in isolation because the interaction and "messiness" of the factors were inherent in their actions and stories about their work and workload. Workload includes not only the easily captured work such as direct care and specific activities such as assessment but also diverse forms of invisible work such as problem solving, rapport building, and caseload management, as well as emotional work such as coping, stress management, and team support. Implications for Case Management: Case managers' work and workload in home care are important phenomena. In a climate of budgetary restraint and an aging population, which seemingly prefer home care as much as the system desires to provide it as a main option for care, it is important to capture, recognize, and legitimize an understanding of case managers' work and workload. Increased knowledge in this area could, in turn, transforms both home care and case management.
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Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative inte...
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Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person's characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person's recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.
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Background/Objective: This study sought to determine whether case management was positively associated with improved outcomes and treatment compliance in those enrolled in a methadone maintenance treatment (MMT) program. Methods: ...
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Background/Objective: This study sought to determine whether case management was positively associated with improved outcomes and treatment compliance in those enrolled in a methadone maintenance treatment (MMT) program. Methods: An intervention group (n = 396) received case management while the other group (n = 1308) did not. Total N = 1704. Results: Statistically significant reductions were seen in the intervention group, in the proportion of urine samples positive for drugs of abuse (relative risk reduction = -15.4% (95% confidence interval (CI): -17.7, -13.1)), missed daily methadone doses (-1.9% (95% CI: -2.4, -1.4)), and missed physician appointments (-40.1% (95% CI: -43.7, -36.3)). ConclusionsScientific Significance: Case management appears to be a very valuable tool in MMT programs.
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Aim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective. Methods: This study was conducted as part of...
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Aim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective. Methods: This study was conducted as part of a larger study that explored the perspectives of clients, caregivers and case managers on case management. All CMs except the CM researchers were recruited. Two CM focus group discussions (FGD) were conducted and facilitated by an experienced independent researcher from the research department. The FGDs were audio recorded and transcribed verbatim with all participants' identifiers omitted to protect confidentiality. Qualitative thematic analysis was conducted using NVivo V.10. (QSR International. NVivo V.10 (Computer software). 2012. ) Results: Eleven themes emerged from the CM FGDs which are based on the CMs' work with both clients and caregivers: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation, support and advocacy. Conclusions: The voices of CMs are important in planning service delivery models and improving the quality of care to clients and caregivers.
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Aim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective. Methods: This study was conducted as part of...
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Aim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective. Methods: This study was conducted as part of a larger study that explored the perspectives of clients, caregivers and case managers on case management. All CMs except the CM researchers were recruited. Two CM focus group discussions (FGD) were conducted and facilitated by an experienced independent researcher from the research department. The FGDs were audio recorded and transcribed verbatim with all participants' identifiers omitted to protect confidentiality. Qualitative thematic analysis was conducted using NVivo V.10. (QSR International. NVivo V.10 (Computer software). 2012. ) Results: Eleven themes emerged from the CM FGDs which are based on the CMs' work with both clients and caregivers: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation, support and advocacy. Conclusions: The voices of CMs are important in planning service delivery models and improving the quality of care to clients and caregivers.
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Background Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly rela...
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Background Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients.
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Purpose of Study: To evaluate whether the Oklahoma State University (OSU) Health Access Network's (HAN's) case management program is effective in reducing the attendance of frequent users to the emergency department (ED) and inpatient department.
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