Abstract
BackgroundCase management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool.MethodsThe process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity.ResultsThe study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more “socially-oriented” type towards a more “clinically-oriented” type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types.ConclusionThe study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0069-1) contains supplementary material, which is available to authorized users.
Highlights
Case management is a type of intervention expected to improve the quality of care and the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes
Basic description of the case management projects The 22 case management projects showed some similarities, as all case managers in the projects were working as a team
Stakeholders of the projects reported that the use of results of research was important to foster high quality care, ideally leading to the use of evidence-based protocols or guidelines, and when possible shared with professionals outside the project organisation. This was reported through a project questionnaire: “What we find really useful is to be able to use the results of the InterRAI-Home Care instrument (HC) instrument, a validated tool which enables us to assess the situation of the person by a multidisciplinary team, really centered on the beneficiary, which in turn improves his engagement in the planning of his own care
Summary
Case management is a type of intervention expected to improve the quality of care and the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. Frail older people often suffer from multiple, interacting morbidities and incapacities They need care of different providers, from both the health care and the social care sector. The split and evolving decision-making power between different policy levels for connected issues lead to a high probability that fragmented care is delivered [1]. This means that the information about the available care agencies and reimbursement statuses is scattered around different levels, changing all the time and very confusing for the care providers, and all the more for the older people and their families
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