Case Management Group Research Articles

Clinical case management of revolving door patients – a semi‐randomized study

To assess the effectiveness of psychiatric clinical case management. Subjects with at least three admissions in the previous 2 years were randomized into a clinical case management group (CMG; n = 122) and a standard care group (SCG; n = 95). Individuals who refused or were not located were included in a third, non-randomized no-treatment group (NTG; n = 153). Parameters assessed included utilization of in-patient services and psychosocial functioning. We found no difference between the CMG and the SCG in psychosocial functioning as evaluated by interviewers, and no difference between the three groups in hospitalization. In subjects' self-ratings, the CMG showed slight improvement in psychosocial functioning. Clinical case management did not prove itself superior to standard care in a revolving door population.

Implementing a Pilot Work Injury Management Program in Hong Kong

This paper reports the results of implementing a pilot case management system for work injuries in Hong Kong. The case management approach was characterized by use of a case manager who worked closely with each of the reported injury cases. The case manager undertook the roles of assessor, referral agent, counselor, work-site liaison, and return-to-work (RTW) expert. A quasi-experimental study design was used. The study compared the RTW and workers' compensation outcomes in injured workers in a cleaning company in a case management group (n = 296) and a conventional rehabilitation group (n = 137). Outcomes of the intervention were followed up at 6 months. The results indicated that the RTW rate was 97.0% and 94.2% for the case management and conventional rehabilitation groups respectively, with no significant differences between them. Participants in the case management group had significantly fewer days of sick leave (mean = 27.5 and 41.6 days, respectively) and lower compensation costs (mean = HK$7,212.2 and $20,617.3, respectively) than those in the comparison group. Age of the participants was found to influence the outcomes with those who were between 41 and 50 years old and received case management intervention had shorter sick leave and lower cost of compensation than their conventional rehabilitation counterpart. The majority of the participants who had returned to work in both the case management (95.8%) and the conventional rehabilitation (96.2%) groups were found to maintain their work status 6 months after the intervention. The findings suggested that applying the case management approach to the Hong Kong workers' compensation system was more effective overall. Nevertheless, the inherent problems associated with implementing such an approach within the existing system, which focuses on compensation and medical interventions, remained unresolved.

An Adaptation of the Diabetes Prevention Program for Use With High-Risk, Minority Patients With Type 2 Diabetes

The purpose of this pilot study was to determine the effectiveness of an edited Diabetes Prevention Program (DPP) Lifestyle Resources Core Teaching Plan for managing patients with type 2 diabetes in an urban underserved setting. Modifications were made to attempt to cut to the bare essentials to work within the constrained budgets of safety net providers. The primary aim was to achieve a mean absolute reduction in HbA1c level of 1 percentage point. The authors conducted a randomized controlled trial of 9 months' duration for patients with type 2 diabetes with an HbA1c>or=8.0%. A total of 67 patients randomized into usual-care and case management groups were evaluated with an intention-to-treat analysis. A modified DPP workbook was used during 7 monthly visits with a nurse case manager. As compared with the usual-care group, those in the case management group experienced a greater reduction in HbA1c level (-1.87 vs -0.54; P=.011) and weight (-2.47 kg vs +0.88 kg; P=.011). Use of an edited version of the DPP workbook in an urban, low-income, minority population with type 2 diabetesproduced a significant absolute reduction in HbA1c percentage and weight.

Case Management and Risk of Nursing Home Admission for Older Adults in Home Care: Results of the AgeD in HOme Care Study

To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care. Retrospective cohort study. Eleven European countries. Three thousand two hundred ninety-two older adults receiving home care (mean age 82.3+/-7.3). Data on nursing home admission were collected every 6 months for 1 year. One thousand one hundred eighty-four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1-year follow-up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43-0.63). Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.

The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically underserved inner-city children attending Memphis City schools. Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size, percentage of children with asthma enrolled, and percentage of children eligible for free or reduced-price lunch. Schools were randomized to either a nurse CM intervention or a usual care (UC) condition. The CM group included 115 students; 128 students were in the UC group. A longitudinal design was used to follow students' progress. Students were primarily African-American children diagnosed with asthma. In CM schools, nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum, followed up on students' school absences, and coordinated students' asthma care with families, school personnel, and medical providers. In UC schools, students received routine school nursing services. CM students had fewer school absences than their counterparts in UC schools (mean 4.38 vs 8.18 days, respectively) and experienced significantly fewer emergency department visits (p < .0001) and fewer hospital days (p < .05) than UC students. No such differences existed before program initiation. Replication and follow-up in year 2 showed continued significant improvements. School-based nurse CM can achieve significant improvements in school attendance and medical utilization.

Lifestyle Intervention in Obese Patients with Type 2 Diabetes: Impact of the Patient's Educational Background

To determine whether people with different educational backgrounds respond differently to a lifestyle intervention program for obese patients with type 2 diabetes. The study consisted of a 12-month randomized controlled trial of 147 health plan members with type 2 diabetes who were overweight or obese (BMI > or = 27 kg/m(2)). Participants were randomized to lifestyle case management or usual care. Case management (CM) involved group and individual education, support, and referral by registered dietitians. Usual care (UC) participants received educational material. Both groups received ongoing primary care. A post hoc analysis was performed, evaluating the impact of education level on intervention group differences with respect to change in weight and waist circumference. There was a significant education by group interaction for both changes in weight (p = 0.02) and waist circumference (p = 0.01) during the study period. Contrary to expectations, CM participants with less formal education had greater risk reductions compared with more educated participants. Models predicted that, by 12 months, those with less education in the UC group gained 1.71 kg more in weight and 3.67 cm more in waist circumference than those with greater education. However, by 12 months, those in the CM group with less education lost a model-predicted 3.30 kg more in weight and 4.95 cm more in waist circumference than those with more formal education. People with varied educational backgrounds may respond differently to a lifestyle intervention for weight management and diabetes control.

The Impact of Cardiovascular Risk Factor Case Management on the Metabolic Syndrome in a Primary Prevention Population: Results From a Randomized Controlled Trial

No study has examined the effect of case management on the development of the metabolic syndrome. The authors randomized 450 consenting, asymptomatic men and women to a 6-month cardiovascular case management program or usual care. Participants were reassessed at 1 year for change in a composite measure of five factors that define the metabolic syndrome. Of the cohort (mean age 42 years; 79% male), 46% had at least one metabolic syndrome factor and 4.3% had the metabolic syndrome. At 1 year, there was greater improvement in motivation to change in the case management group (+0.58 vs. +0.06, 10-point scale; p = 0.001), lower incidence of the metabolic syndrome (1.5% vs. 4.5%; p = 0.12), and lower prevalence (decrease of 0.8% vs. increase of 2.6%; p = 0.04). A 6-month case management program focused on cardiovascular risk factors had a modest effect on the prevalence of the metabolic syndrome in this primary prevention screening population after 1 year. Further study is needed to clarify the overall health impact of preventing the metabolic syndrome.

Cost-Effectiveness of Case Management in Substance Abuse Treatment

Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management and one telecommunication case management, and the fourth was the control group. Results: Using a ratio of cost to days free from substance abuse, the case management groups were less cost-effective than the control group at 3 months, 6 months, and 12 months. The telecommunication case management was least cost-effective of the three case management conditions. Conclusion: Results from the analysis revealed case management is not cost-effective as a supplement to traditional drug treatment over a 12-month follow-up period.

Case management and adherence to an online disease management system

Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.

Education and Telephone Case Management for Children With Type 1 Diabetes: A Randomized Controlled Trial

The purpose of the study was to compare three nursing interventions and their impact on glycemic control among children with type I diabetes. The 75 subjects' mean +/- SD age was 12.5 +/- 3.4 years, 55% were boys, and 55% were White. Subjects were randomly assigned to a standard care (SC), an education (ED), or an education and telephone case management (ED + TCM) group. The primary outcome measure was glycemic control (hemoglobin A1c, or HbA1c). Secondary outcome measures were diabetes knowledge (KNOW), parent-child teamwork (TEAM), and adherence (ADH). After 6 months of follow-up, results demonstrated no significant differences among groups in HbA1c. KNOW and TEAM scores improved slightly in the ED and ED + TCM groups, but no statistically significant differences were found among the three groups. Significant improvement in ADH scores among ED + TCM groups was reported when compared with the ED and SC groups. This change may represent a move toward improved adherence to diabetes care and subsequent improvement in diabetes control. The challenges of recruitment and retention of subjects in this study will also be discussed.

Community Case Management: A Strategy to Improve Access to Medical Care in Uninsured Populations

Case management is a rapidly growing strategy to help vulnerable populations access the health care they need in a fragmented U.S. service delivery system. A number of lessons can be learned from the successes and challenges of a developing, hospital-based, community-focused case management group in Sedgwick County, Kansas. The Community Case Management program has a case management team based at each of four hospitals. Each team has a social worker and a nurse, whose main goal is to help the uninsured find a primary health care home. This dynamic combination has several benefits. Each team member brings a vital skill set in helping the clients change behavior and access the care and support they need. Also, the nurse-social worker team concept creates a synergy in which team members support each other and create the best solution to their clients' needs.

Best Practice in Long-Term Care Case Management

Abstract Case managers identified as “excellent” by quality reviewers, evaluators, and advocates were interviewed in order to learn how they did their jobs. A second group of case managers whose work was described as “very good” or adequate also were interviewed. Analysis of these interviews found six processes that characterized excellence: honoring the spirit of the rules; risk taking; nurturing the personal side of relationships; managing without formulas; listening and knowing; and relating to supervisors. The key role of supervisors in providing support was also identified. The authors suggest how the findings could be used to improve recruitment, training, and supervision of case managers.

Skill Development and Problems in the Achievement of Transfer of Training Effects: Some New Zealand Rehabilitation Case Manager Data

We examined the impact of a 27-week university-based professional training program on the self-rated skills and competencies of a group of New Zealand rehabilitation case managers. The extent to which training-related change transferred back to the workplace at both the individual and organisational level was also considered. Some pre-test/post-test increases in self-rated competencies were observed and these were maintained at 3-month follow-up. Training-related change back in the workplace was generally perceived to be in a negative direction, which highlights the fact that the relationship between the training process and subsequent skill/knowledge utilisation in the workplace is a complex and non-linear phenomenon. Some suggestions as to how research on training in rehabilitation might move forward are presented.

Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care

Objectives: To establish whether intensive case management reduces violence in patients with psychosis in comparison with standard case management.Design: Randomised controlled trial with two year follow up.Setting: Four inner city...

Chloroquine prophylaxis, iron-folie acid supplementation or case management of malaria attacks in primigravidae in western Uganda: effects on maternal parasitaemia and haemoglobin levels and on birthweight

The effects of weekly chloroquine prophylaxis, daily iron-weekly folic acid supplementation or passive case management on maternal haemoglobin and parasitaemia and on birthweight were examined in primigravidae in a randomized, double-blind placebo-controlled intervention trial in 1996–1998 in Hoima District, western Uganda. Iron-folic acid supplementation significantly increased mean birthweight as compared to case management ( P = 0·03). Low birthweight (< 2·5 kg) occurred in 2% of babies of women receiving chloroquine prophylaxis for ≥ 8 weeks and in 9% in the case management group (RR = 0·36, 95% CI 0·13–1·00, P = 0·009). Parasitaemia at enrolment significantly correlated with low birthweight in the case management group as compared to the intervention groups ( P = 0·02). Women in the case management group who were parasitaemic and had haemoglobin levels < 100 g/L at delivery had babies with lower mean birthweight as compared to babies in the other groups ( P = 0·04). Low haemoglobin level at enrolment, irrespective of parasitaemia status, was a predictor of low birthweight in the case management group only ( P = 0·04). Chloroquine prophylaxis and iron-folic acid supplementation significantly increased maternal haemoglobin levels during pregnancy as compared to case management ( P = 0·01 and 0·007, respectively) and the increase correlated to the duration of the intervention.

United Resource Networks: how compliance issues affect a managed care transplant network

UNITED Resource Networks provides access to the nations’s leading medical delivery systems specializing in transplantation. The United Resources Networks Transplant Network was established in 1987 by contracting the transplant centers for United Healthcare. In 1991, URN began providing its national organ and tissue transplant network to non-United Healthcare payors. The URN Transplant Network is currently utilized by over 1400 customers including HMOs, indemnity carriers, self-funded employer groups, and resource distributors, such as reinsurers, stop-loss carriers, managing general underwriters (MGUs), and utilization and case management groups. Presently, there are 49 participating medical centers with over 123 solid-organ or tissue transplant programs in the URN Transplant Network. Transplant programs qualify for inclusion in the Transplant Network by undergoing a thorough program-credentialing process that evaluates the clinical and practical criteria shown in Table 1. Programs included in the Network undergo annual and ongoing evaluation by the URN Quality Management Team. Changes in team or physician leadership, specific patient or client concerns, or changing trends in clinical outcomes or administrative services are closely monitored to assure the standards for which a program was chosen for the Network are being maintained. In addition, Patient Satisfaction Surveys are performed and shared with the contracted centers on a routine basis. United Resource Networks negotiates global transplant package rates, which include evaluation, organ or tissue procurement, pretransplant and inpatient care, professional fees, ancillary services, and up to 12 months’ follow-up care for various transplant categories. United Resource Networks recently announced a Pediatric Transplant Network that was formed using criteria relating specifically to pediatric patients. In addition, URN provides a variety of strategic educational conferences and seminars throughout the year. Offerings include three Transplant Conferences for Payor Medical Directors, two Courses in Transplantation for Case Managers, and an Annual National Clinical Conference, which brings payors and providers together to discuss the changing trends in transplantation.

A nursing intervention to decrease depression in family caregivers of persons with dementia

The goal of this study was to evaluate a community-based psychoeducational-nursing intervention designed to teach home caregivers to manage behavioral problems of persons with Alzheimer's disease and related dementias (ADRD) using the Progressively Lowered Stress Threshold (PLST) model, and to compare this intervention with routine information and referrals for case management, community-based services, and support groups. Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers' physical and mental health, and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported. Therefore, a primary aim was to evaluate the impact of the intervention on caregivers' affective responses, especially depression. Data from both the Profile of Moods States and the Geriatric Depression Rating Scale support the effectiveness of this intervention in decreasing depression among caregivers who received the experimental training. Additional analysis of factors associated with caregiver depression are also reported. The pivotal role of psychiatric nurses in the assessment and treatment of depression among caregivers of persons with ADRD is discussed.

Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection.

A fever case management (CM) approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intertmittent SP treatment regimens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria transmission in western Kenya. The investigation evaluated efficacy of the antimalarial regimens for prevention of placental malaria and examined the effect of human immunodeficiency virus (HIV) infection on antimalarial drug efficacy and adverse drug reactions. Twenty-seven percent (93 of 343) of pregnant women in the CM group had placental malaria compared with 12% (38 of 330; P < 0.001) of women who received two doses of SP and compared with 9% (28 of 316; P < 0.001) of women who received monthly SP. Fourteen percent (49 of 341) of women in the CM group delivered low birth weight (LBW) infants compared with 8% (27 of 325; P=0.118) of women who received two doses of SP and compared with 8% (26 of 331; P=0.078) of women who received monthly SP. Seven percent (7 of 99) of the HIV-negative women on the two-dose SP regimen had placental malaria compared with 25% (10 of 39; P=0.007) of HIV-positive women on the same regimen; the rate of placental malaria in HIV-positive women was reduced to 7% (2 of 28; P=-0.051) for women on the monthly SP regimen. Less than 2% of women reported adverse drug reactions, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and efficacious for the prevention of placental malaria in pregnant primigravidae and secundigravidae in sub-Saharan Africa. While a two-dose SP regimen may be effective in areas with low HIV seroprevalence, administration of SP monthly during the second and third trimesters of pregnancy should be considered in areas of high HIV seroprevalence to prevent the effects of maternal malaria on the newborn.

Improving Substance Abuse Treatment Access and Retention Using a Case Management Approach

The effectiveness of a case management model in improving treatment access, retention, and outcomes was examined within a cohort of 360 intravenous drug users (IDUs) pursuing substance-abuse treatment through a central intake facility. IDUs were randomly assigned either to the case management group or to the comparison group. In the case managed condition, IDUs received assistance from their case manager in identifying and accessing needed services, including substance abuse treatment. In the comparison condition, IDUs received limited referral information for substance abuse treatment. Clients in the case managed group accessed substance abuse treatment in significantly greater numbers and more rapidly than clients in the comparison group. Case-managed clients also remained in substance abuse treatment nearly twice as long as did comparison group clients. Finally, case-managed clients showed better treatment outcomes including reduced alcohol and drug use.

Early Discharge Program in a NICU Can be Cost Effective Without Compromising Quality. † 831

We hypothesized that an Early Discharge Program (EDP) using case management(CM) to facilitate earlier discharge (d/c) of preterm infants to home or transfer to level II hospital would be cost effective without compromising quality. The EDP was instituted on 1/1/96. Infants born 1/1/96-6/30/96 at<30wk GA were included in the analysis. Infants were excluded for transfer or death prior to 30wk postmenstrual age (PMA). CM included involvement of family, patient care coordinator, primary care physician, neonatologist and home nursing. D/C criteria were based on physiologic stability and included:3 34wks PMA, po feeds, thermostability in an open crib, infrequent apnea and FiO2 requirement <30%. Infants were considered for transfer to a level II facility when medically stable with FiO2 requirement <30% and on enteral feeds. Families were contacted within 4 wks of d/c to assess parent satisfaction and post-d/c healthcare utilization. CM infants were stratified into 2 categories based on GA at birth and compared with a retrospective control (CTL) group (7/1/94-6/30/95) for NICU length of stay (LOS) and d/c wt[mean (SD)]: Table Regression analysis, controlled for gender, BW, 5 min apgar, insurance and race showed that LOS was decreased in the CM group by 7d (p=0.02). Using a 4 point rating system, all of the parents contacted, indicated that they were highly satisfied with the discharge preparations. ER visits and readmission within 2 wks of d/c were infrequent and not related to early discharge. Given that the average charge for an NICU is $2,000/day, we conclude that the preliminary data suggests that this ED program will have a substantial effect on NICU expenditures with no demonstrable compromise to healthcare delivery or parent satisfaction.