Abstract
Introduction:Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use.Methods:A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada).Results:Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers’ access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use.Conclusion and discussion:This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.
Highlights
Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost
While the number of frequent users increased considerably in the case A and increased slightly in the case D, an important decrease was observed for the case C and a slight decrease in the case F
Our results suggest that where staff turnover and health care team instability, was present due to organizational issues and the health system reorganization, negative impacts on care integration, especially regarding communication and care transitions, were observed
Summary
Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. Case management programs (CMP) for frequent users of healthcare services with complex needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost [10,11,12]. The case manager is a key practitioner or navigator (often a nurse or a social worker) who evaluates, plans, implements, coordinates, and prioritizes services based on individuals’ needs, and offers self-management support in close collaboration with health, social and community partners [13]
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