Abstract
BackgroundThe aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions.MethodsA qualitative case study design was used; semi-structured interviews were conducted with 22 stakeholders on the execution and continuation phases of the implementation process. The stakeholders represented a broad range of perspectives (i.e. project leaders, case managers, health insurers, municipalities).ResultsThe independence of the case management organization in the intensive model facilitated the implementation, whereas the presence of multiple competing case management providers in the linkage model impeded the implementation. Most impeding factors were found in the linkage model and were related to the organizational structure of the dementia care network and how partners collaborate with each other in this network.ConclusionsThe results of this process evaluation show that the intensive case management model is easier to implement as case managers in this model tend to be more able to provide quality of care, are less impeded by competitiveness of other care organizations and are more closely connected to the expert team than case managers in the linkage model.
Highlights
Introduction of theDBC: it included tasks that case managers performRedistributing funding across regions by health care agency based on needs of regionsImpeding As project funding ended, project leaders and coordination points were omittedLack of full insurance cover for case management led to fragmentation of financial supportIn some regions diagnostics and treatment are funded by the Health Insurance Act, but not in all of themDBC does not cover all case management tasks education and substantial caseload, whereas the part-time availability of case managers made them less accessible to informal caregivers or professionals
Collaboration with other care providers in the dementia care network can be optimized in the intensive model by providing transparency towards other care providers about the content of case management and reaching clear agreements about who is responsible for which aspects of client care within the dementia care network
The independence of the case management provider in the intensive model enables case managers to attune care to what is in the best interest of the client instead of what is best for the case management organization
Summary
Introduction of theDBC: it included tasks that case managers performRedistributing funding across regions by health care agency based on needs of regionsImpeding As project funding ended, project leaders and coordination points were omittedLack of full insurance cover for case management led to fragmentation of financial supportIn some regions diagnostics and treatment are funded by the Health Insurance Act, but not in all of themDBC does not cover all case management tasks education and substantial caseload, whereas the part-time availability of case managers made them less accessible to informal caregivers or professionals. Everybody thought they could do the best job (participant 3).” The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. This heterogeneity may explain the mixed effects of case management in dementia to date [5,6]
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