Implementing a Case Management Program Designed to Enhance Primary Care Physician Practice With Older Persons

Abstract

A qualitative analysis of the implementation of a case management program is presented. This collaborative research design uses semistructured interviews and observational field methods. Nested within a changing health care environment and a corporation that is restructuring, three physician practices form the intervention sites. During the course of the project there is high turnover among project staff and physicians. This analysis begins with the intervention in which case managers mobilize resources, monitor medication and health care compliance, educate elderly participants and physicians, counsel participants, and provide caregiver support and follow-up. Adjusting to and defining the case management role, structuring supervision and nurturing the intervention, and communicating (both written and face-to-face) with diverse physicians are ongoing tasks throughout project development. The importance of clear communication, the need for great flexibility, and the search to maintain project integrity (keeping sight of the intervention) emerge as critical themes.