Case Management Program Research Articles

Using the RE-AIM framework to evaluate the implementation of integrated community case management in Kenya.

To evaluate an integrated community case management programme for sick children aged 2 to 59months in western Kenya using the Research, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. This was a prospective observational research project conducted between December 2013 and February 2016. Outcome variables were measured before, during and at end of implementation using a series of surveys as well as by looking at routine service statistics. A total of 2604 community health workers were trained in 245 community units. The average post-training knowledge level (73.5%) and retention rates (89.7) of trained community health workers was high. At the end of study, there was an increase in the proportion of children who received appropriate treatment for diarrhoea (49.2%), pneumonia (19.5%), malaria (16.4%) and vitamin A (51.5%) from baseline. Community health workers were able to assess, classify and treat sick children with a similar quality as that provided by facility-based healthcare workers (>85% concordance). Based on the RE-AIM metrics, our results demonstrate promising practical approaches and outcomes of a large-scale implementation of integrated community case management in western Kenya. The findings have important implications for future design and expansion of the programme in Kenya.

Un exemple de système de veille post-hospitalière des suicidants : VigilanS

BackgroundAttempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor in a context where social connection seems compromised and a source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and case management programs that rely on a “stay in contact” dimension. These programs, initiated by Jerome Motto and its short letters may consist of: (1) sending letters or postcards after discharge of the ER; (2) giving a crisis card that offers a crisis telephone line and a crisis unit for hospitalization if needed, and; (3) placing a phone call at some time distance after the discharge. The aim is to enhance a “connectedness feeling” with the patient. These different strategies have proven to be even more effective in some specific subgroups, highlighting the heterogeneity of this population. Each modality of contact was well accepted and generated a positive involvement of the patients. MethodIt led to the idea of combining these different strategies in an algorithm built on the specificity of identified subgroups. A randomized controlled trial, named ALGOS was carried out in France to test this algorithm in 2011. The algorithm consisted of: (1) delivering a crisis card for first attempters; (2) giving a phone call for re-attempters to re-assess their situation between the 10th and 21st day after their discharge, and to propose a new intervention if needed, and; (3) in case of an unsuccessful call or a refusal of proposed care, sending personalized postcards for 6 months. All of this was supported with shared information to the general practitioner of the patient. This study was further adapted to routine care in 2015 in the northern departments of France, Nord and Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists of sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS in order to provide information about the patient and the context of his suicide attempt. The algorithm has been modified in giving the crisis card to all the patients whether it is a first attempt or not. An information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of 4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department on a halftime basis and manage the incoming calls from the patients as well as the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed in case of an inconclusive or a failed phone call. ConclusionBuilt on a monitoring philosophy, VigilanS has further developed a real crisis case management dimension requiring enough time to insure an effective medical supervision and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. This program expertise, designed by Northern departments to prevent suicide, can be shared with other French or even foreign territories.

Case management for home-bound older adults in New York City: what is an appropriate caseload size?

ABSTRACTAs the USA ages rapidly, greater attention is being paid to keeping older adults healthier and living independently as long as possible. Long-term care is growing increasingly cost-prohibitive and is not seen as a necessary service for all older adults. For those older adults who need supports and assistance to live in their own homes, home-based case management programs provide an array of services. However, case management organizations are under-resourced and struggle to meet the complex needs of the aging population. As a result, caseload sizes for case managers have grown exponentially and directly impact the quality of services provided. This study reports on a collaborative endeavor between a government agency, service provider organizations, case managers, and a gerontologocal researcher in New York City to highlight the challenges faced by case management agencies and develop a scientific process for calculating adequate caseload sizes. Implications for social service agencies and public policies are illustrated.

Optimization of Antipsychotic and Benzodiazepine Drugs in Patients with Severe Mental Disorders in an Intensive Case Management Program

The Intensive Case Management (ICM) model is a community-based program for people with severe mental illness that may reduce hospitalization and increase retention in care. The aims of this study were to analyze changes in the antipsychotic and benzodiazepine dosage in 106 patients who participated in an Individualized Service Program based on the ICM model for at least 6months and to assess the change in the number of patients taking a high or very high dose of an antipsychotic drug and the number receiving antipsychotic polytherapy. Both the average daily dose of antipsychotic and benzodiazepine drugs and the number of patients with high doses of antipsychotic and more than one antipsychotic drug decreased significantly. Implementing the ICM program in patients with severe mental illness could help to decrease adverse drug effects and health care expenditures.

Inter-Relationship Between Frailty & Multimorbidity in East Berkshire, UK.

Introduction: In 2015, Slough Clinical Commissioning Group (CCG) undertook an analysis of their population which confirmed that multimorbidity more than any other variable is the key driver of healthcare resource use and future risk amongst their population. As a result of this intelligence, a new service was established to provide support to a segment of this population with comorbidity combinations that GPs felt they could manage more effectively in primary care with some additional funding. Following on from the success of this Complex Case Management programme, Slough CCG and its two neighbouring CCGs applied the same analytical approaches to: Gain a greater understanding of how frailty is distributed across the 3 CCGs in East Berkshire Quantify resource use by people in the different frailty categories Understand the inter-relationship between frailty and multimorbidity Understand the relationship between degrees of frailty and risk of adverse outcomes such as risk of emergency admission and risk of future high cost Method: An anonymised data set combining data from the GP record and hospital activity was used to profile the entire population of around 450,000 people. The data set contained data relating to all diagnoses, degree of morbidity burden (as measured by the Johns Hopkins ACG System), risk of future adverse events (e.g. hospitalisation, high cost), prior cost and the degree of frailty the person had (as measured by the Electronic Frailty Index). The analysis focused on relationships and correlations between variables such as age, multimorbidity, degree of frailty and prior cost. Results: Results will be shared that illustrate new understanding and insights about the inter-relationship between frailty and multimorbidity. These results include: As the degree of frailty increases so do costs and resource use. However, it is multimorbidity more than frailty that drives cost and resource use, especially in relation to emergency admissions There is 1.5% of the population with both high levels of frailty and multimorbidity who it makes sense to target for intervention but over 50% of patients most at risk of high cost and emergency admission are not moderately or severely frail Between 47% and 55% of patients who are moderately or severely frail are not amongst the patients most at risk of being high cost or having an emergency admission Discussion: There is a great deal of focus on the issue of frailty in the English National Health Service. Whilst it is true that resource use increases with an increasing degree of frailty, this analysis has demonstrated that not all frail patients are high cost and not all high cost patients are frail. The importance of this study is that it highlights the need to: Undertake robust population health analyses to gain a thorough understanding of the different segments of the population, to identify the characteristics of those segments and to understand the inter-relationships between them. Choose the right algorithm or case finding technique to identify the segment of the population that you want to make an impact upon

The Development of Cancer Patient Navigation Program in Taiwan

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study

Background and objectiveTo assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. Patients and methods472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. ResultsEQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08–0.30), but was not different to telephone support (diff: 0.04, −0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. ConclusionsTelehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562).

Protocol for a prospective multicentre registry cohort study on suicide attempters given the assertive case management intervention after admission to an emergency department in Japan: post-ACTION-J Study (PACS)

IntroductionSuicide attempt is the most important risk factor for later suicide. A randomised-controlled, multicentre trial of postsuicide attempt case management for the prevention of further suicide attempts in Japan, named...

Nutritional screening in a case management program for community-living older individuals at high risk of hospital admission.

The prevalence of malnutrition in older persons depends on the healthcare setting. In recent years, hospital-based case management programs (CM Programs) targeting individuals in the community with chronic multimorbidity and high use of hospital resources (admissions or emergency visits) have been developed in many countries to reduce the need for complex health care. The objective of this study was to assess the prevalence of risk of malnutrition, using the Short Form of the Mini-Nutritional assessment, of community dwelling patients included in a chronic CM Program. Factors associated with malnutrition risk were also explored. Patients included in a hospital-based integrated CM Program for older persons at high risk for hospital readmission after an index admission were studied. MNA-SF was used at program inclusion to assess the risk of malnutrition. An array of factors potentially associated with malnutrition were explored (including feeding route, use of dental prosthesis, dysphagia, consistency of foods, specific therapeutic diets, use of oral nutritional supplements, polypharmacy, falls, and other diseases and geriatric syndromes). 791 participants were included, mean age 79.8years, 50.1% females. Risk of malnutrition was present in 44.9%. Participants at risk of malnutrition were more frequently female, had a lower BMI, were less likely to be fed orally and used more nutritional supplements. They also had a higher prevalence of dysphagia, needing changes in food consistency or using specific therapeutic diets, and had dementia or cancer more frequently. They also showed a higher need for palliative care. Risk of malnutrition in patients included in a CM Program is higher than in non-selected community dwelling older individuals. This information may help inform screening policies in similar populations at risk of hospital readmission.

P43. Dysphagia and difficulties with tablet intake in ALS – Assessment from the patient perspective

Background Dysphagia is a frequent and severe symptom in amyotrophic lateral sclerosis (ALS) ( Onesti et al., 2017 ).It disturbs nutrition and medication intake and leads to aspiration of liquids as well as solid substances.Dysphagia frequently results in unintended weight loss and may require the use of percutaneous endoscopic gastrostomy (PEG). Although dysphagia and PEG are known barriers for tablet intake in ALS, few systematic investigations have been reported so far. Methods 650 patients with ALS, who participated in an ALS-centered case management program (Ambulanzpartner) and were registered on the program-related case management platform (Ambulanzpartner-Versorgungsportal; www.ambulanzpartner.de) were invited to answer a survey about ALS-related dysphagia.203 patients (31%) conducted an online self-assessment (n = 97; 48 %) or were interviewed via telephone (n = 106; 52%).The assessment was carried out between December 2016 and February 2017. Results Dysphagia was reported by 61% (n = 123) of ALS patients.In 21% (n = 42) severe dysphagia necessitated the use of PEG ( Fig.1 ).41% of participants (n = 84) experienced difficulties with tablet intake, which was reported as sticking at palate and tongue, melting in mouth, irritation of the throat, and fear of choking.In 27% (n = 55) tablet intake was impossible due to dysphagia ( Fig.2 ).These patients reported an inappropriate crushing of medication for oral intake or administration of the crushed tablets via PEG tube. Conclusion Dysphagia and difficulties with tablet intake occurs frequently in patients with ALS. Crushing tablets was shown to be a ‘routine’ practice to overcome dysphagia-related difficulties of tablet intake although the grinding of tablets poses the risks of reduced bioavailability, of tube obstruction and of unwanted drug interactions – if different crushed tablets are given at once.The results of this assessment underline the importance of liquid formulations and suspensions of ALS-related drugs to ensure a save and appropriate administration of medicines during the course of ALS. Acknowledgements This work was supported by a grant of DESITIN Arzneimittel GmbH to Ambulanzpartner Soziotechnologie GmbH. Conflicts of interest TM and CM are founders of the internet platform Ambulanzpartner and hold shares of Ambulanzpartner Soziotechnologie GmbH.

Impact of Health Care and Socioeconomic Needs on Health Care Utilization and Disease Management: The University of New Mexico Hospital Care One Program.

Understanding how unmet basic needs impact health care in patients with complex conditions is vital to improve health outcomes and reduce health care costs. The purpose of this observational study was to explore the association between health care and socioeconomic needs and health care utilization and disease management among patients with chronic conditions at an intensive, patient-centered, office-based program. The study used a cross-sectional design and a convenience sampling approach. Data were collected through a patient questionnaire and medical records. Analysis included descriptive and inferential statistics. Data from 48 established patients were analyzed. Financial and lack of transportation were the 2 most frequently reported unmet needs. More than 65% of participants had their chronic condition(s) under control. Sex and ethnicity were the only 2 demographic variables that yielded significant differences (P ≤ 0.01) on visits to the emergency room and having chronic condition(s) under control. Those who reported having unmet transportation needs were more likely to have a condition uncontrolled and to have lost medical appointments compared to those who had this social need met (P ≤ 0.05). Statistically significant differences in terms of missing medical appointments also were found between those whose overall financial and housing needs were unmet and those who had those needs met (P ≤ 0.05). Results indicate that participating patients generally had good control of their conditions. The study adds evidence in support of the call for health care to address patients' socioeconomic needs, and the health care benefits of intensive case management programs. The model may be considered for adoption throughout New Mexico, and nationally.

Case Management: Transforming Health Care Environment.

Case Management: Transforming Health Care Environment.

Home Care Case Managers' Integrated Care of Older Adults With Multiple Chronic Conditions: A Scoping Review.

The purpose of this scoping review was to explore peer-reviewed research and gray literature to examine the extent, range, and nature of available research that describes how home care case managers (HCCMs) provide integrated care for older adults with multiple chronic conditions (MCCs); identify how case management standards of practice correspond with functions of integrated care; identify facilitators and barriers to case management and integrated care delivery; and propose a framework to describe how HCCMs can use case management standards to provide integrated care to older adults with MCCs. Community, home care settings. Scoping review; older adults older than 65 years with MCCs, case managers and health care professionals who provide care for older adults with MCCs. The study findings demonstrated that HCCMs consistently used the case management standards assessment, planning, implementation, and evaluation to provide all professional and clinical integrated care functions, and were least likely to use the standards of identification of client and eligibility for case management and transition to provide professional and clinical integrated care functions. In addition, HCCM use of professional and clinical integrated care functions was inconsistent and varied based on use of case management standards. All case management standards and integrated care functions were found to be both facilitators and barriers, but were more likely to facilitate HCCM work. Interestingly, the standards of assessment, planning, and implementation were more likely to facilitate functional integration, whereas the integrated care functions of intra- and interpartnerships, shared accountability, person centered of care, and engagement for client self-management were more likely to facilitate normative integration. We also found that HCCMs use case management standards and integrated care functions to provide care for older adults with MCCs at the professional (meso) and clinical (micro) levels. Variations in HCCM practice may impact the delivery of case management standards when caring for older adults with MCCs. This has implications for the comprehensiveness and consistency of HCCM practice, as well as interdisciplinary health professional and the client's awareness of the HCCM role when providing integrated care to older adults with MCCs within home settings. The greatest facilitators and barriers to integrated care are those case management standards and clinical and professional integrated care functions that focus on partnerships, collective and shared responsibility and accountability, coordinated person centered of care for clients, and ensuring engagement and partnership in self-management. This indicates the need for development of case management policies and programs that support the work of HCCMs in the delivery of seamless and collaborative case management and integrated care functions that foster collaboration and partnership-building efforts. The development of a new case management and integrated care conceptual framework that includes case management standards, professional and clinical integrated care functions would guide HCCM integrated care practice, policy and research to support client and family-centered care, and foster shared values for sustainable partnerships across care settings.

Corrigendum.

Psycho-OncologyVolume 27, Issue 7 p. 1872-1872 CORRIGENDUMFree Access Corrigendum This article corrects the following: Effects of a health education and telephone counseling program on patients with a positive fecal occult blood test result for colorectal cancer screening: A randomized controlled trial Hui-Chuan Chiu, Hsin-Yuan Hung, Hsiu-Chen Lin, Shu-Ching Chen, Volume 26Issue 10Psycho-Oncology pages: 1498-1504 First Published online: December 2, 2016 First published: 12 July 2018 https://doi.org/10.1002/pon.4765AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The authors wish to bring to the readers' attention the following error in the article by Chiu et al.,1 “Effects of a health education and telephone counseling program on patients with a positive fecal occult blood test result for colorectal cancer screening: A randomized controlled trial.” In section 2.3.2 (page 1499), “Oral Precancerous Lesions Case Management Program” was inserted in error. It should read as “Colorectal Cancer Health Education and Telephone Counseling Program”. The authors apologize for this error and any confusion that it may have caused. REFERENCE 1Chiu H-C, Hung H-Y, Lin H-C, Chen S-C. Effects of a health education and telephone counseling program on patients with a positive fecal occult blood test result for colorectal cancer screening: A randomized controlled trial. Psycho-Oncology. 2017; 26(10): 1498- 1504. https://doi.org/10.1002/pon.4319 Volume27, Issue7July 2018Pages 1872-1872 ReferencesRelatedInformation

Case management effectiveness for managing chronic illnesses in Korea: a systematic review.

Case management has been adopted in Korea and been recognized as a promising care-coordination method that lowers costs and improves quality of care. However, the effectiveness of case management among individuals with chronic illnesses who reside in the community has yet to be established. This systematic review identifies and synthesizes recent evidence of case management's effectiveness in managing chronic illnesses among adults in Korea. The methodology of this systematic review was guided by the Cochrane processes and PRISMA statements. A search of multiple bibliographic databases to identify studies of case management in the populations of Koreans adult with chronic illnesses was conducted. Studies that met the inclusion criteria were published in English or Korean. Nine empirical peer-reviewed studies published between 2008 and 2016 were selected for review. The retrieved studies show that case management programmes in Korea for adults with chronic illness in the community were led by nurses. There was strong evidence that nurse-led case management was effective in improving psychobehavioural and objective clinical outcomes; however, results for health services utilization outcomes were mixed. In future, research with rigorous study designs and large sample size in multiple settings are needed to further assess the effectiveness of case management in Korea. Nurse-led case management would be of support in the care of chronic illnesses not only in Korea but also in Asian countries which share standard practice of case management with Korea. Nursing leaders should allocate resources to sponsor educational resources and practical strategies for evidence-based case management.

Motivation and satisfaction among community health workers administering rapid diagnostic tests for malaria in Western Kenya.

BackgroundThe continued success of community case management (CCM) programs in low-resource settings depends on the ability of these programs to retain the community health workers (CHWs), many of whom are volunteers, and maintain their high-quality performance. This study aims to identify factors related to the motivation and satisfaction of CHWs working in a malaria CCM program in two sub-counties in Western Kenya.MethodsWe interviewed 70 CHWs who were trained to administer malaria rapid diagnostic tests as part of a broader study evaluating a malaria CCM program. We identified factors related to CHWs’ motivation and their satisfaction with participation in the program, as well as the feasibility of program scale-up. We used principal components analysis to develop an overall CHW satisfaction score and assessed associations between this score and individual CHW characteristics as well as their experiences in the program.ResultsThe majority of CHWs reported that they were motivated to perform their role in this malaria CCM program by a personal desire to help their community (69%). The most common challenge CHWs reported was a lack of community understanding about malaria diagnostic testing and CHWs’ role in the program (39%). Most CHWs (89%) reported that their involvement in the diagnostic testing intervention had either a neutral or a net positive effect on their other CHW activities, including improving skills applicable to other tasks. CHWs who said they strongly agreed with the statement that their work with the malaria program was appreciated by the community had a 0.76 standard deviation (SD) increase in their overall satisfaction score (95% confidence interval CI = 0.10-1.24, P = 0.03). Almost all CHWs (99%) strongly agreed that they wanted to continue their role in the malaria program.ConclusionsOverall, CHWs reported high satisfaction with their role in community-based malaria diagnosis, though they faced challenges primarily related to community understanding and appreciation of the services they provided. CHWs’ perceptions that the malaria program generally did not interfere with their other activities is encouraging for the sustainability and scale-up of similar CHW programs.

“Our lives aren't over”: A strengths-based perspective on stigma, discrimination, and coping among young parents

The current study conducted interviews and focus groups with twenty-four diverse 16-25 year-old parents to elicit in-depth narratives about experiences related to parenting status. Parents were recruited from a case management program in the Southwestern United States supporting high school graduation and workforce employment (for mothers and fathers, respectively). Young parents disclosed experiences of shame, stigma, and discrimination associated with perceptions about their “fitness” to be a parent and moral judgment. Themes arose that revealed the positive, adaptive ways that participants coped with potentially deleterious experiences with a focus on their role as a parent and role model for their children. Our findings highlight positive meaning-making and resiliency of young parents when confronted with discrimination and systemic barriers, with many participants focusing on the benefits of parenthood within a unique developmental context. Further, implications for program development, provider trainings, and public policy and advocacy efforts for young parents are discussed.

Real World Effectiveness of Golimumab Therapy in Ulcerative Colitis Regardless of Prior TNF Exposure.

BackgroundThe efficacy of golimumab to induce and maintain remission in biologic-naïve patients with ulcerative colitis (UC) is established from placebo-controlled trials. However, golimumab’s real-world effectiveness, important to physicians and payers, remains unexplored.AimThe goal of this study was to describe real-world use and rate of persistence among UC patients with golimumab therapy and to assess factors that predict discontinuation during golimumab maintenance treatment.MethodsA retrospective study of UC patients receiving golimumab maintenance therapy (August 2012–August 2015) was conducted on dosing data from a national case management program. Treatment persistence, defined as time from index prescription to the last dose (gap in dose >60 days), was assessed using Kaplan-Meier survival analysis. Predictors of treatment persistence were explored with Cox proportional hazards regression.ResultsOne hundred thirty-six patients (50.7% male) with a mean (SD) age of 44.4 (15.6) years were included. At golimumab initiation, 72.1% were naïve to anti-TNFs; 77.2% received 200 mg, while 4.4% and 18.4% received 50 mg and 100 mg, respectively, every 4 weeks (induction therapy). The median time to discontinuation was 530 days, with a cumulative probability of 63% to remain on therapy at one year. Age, gender, golimumab induction, golimumab maintenance dose and prior anti-TNF exposure were not significantly associated with treatment persistence. Dose adjustment occurred in 7.4% of patients during maintenance treatment.ConclusionsOverall, the persistence rate of golimumab observed in the current real-world study is similar to that described in previous single-centre UC cohorts and consistent with that seen in controlled clinical trials.

The Integrated Case Management Program: Essential for Today's Case Manager.

I thought that most health care professionals, and ertainly case managers, were beyond segregating physical health, mental health, and behavioral health. However, I was mistaken. As recently as last week, I overheard a hospital case manager tell her manager that she was not trained in mental health

PHS71 - Applying Population Health Management Techniques to Lower Healthcare Utilization in Patients with Non-Chronic Complex Diseases

The objective of this study was to evaluate the effectiveness of the Blue Touch Complex case management (CM-Complex) program for patients with non-chronic complex diseases who are Blue Cross Blue Shield of Louisiana (BCBSLA) members. In-state BCBSLA members with non-primary Medicare who were referred to the BCBSLA CM program one time from January 2014 to June 2016 and had at least 9 months of enrollment were included in this study. Members that chose to participate and complete the CM program were compared to members that were referred but unable to contact. Patients were stratified based on their DxCG risk score as follows: healthy, stable, at risk, struggling, and in crisis. A weighted propensity score was calculated for treatment and control group by each stratum. Healthcare utilization and expenditures were compared using Difference in Difference multivariable regression models controlling for all covariates via a weighted propensity score and additional demographic and insurance product enrollment variables. There were 453 CM-Complex and 3,625 control patients who met all inclusion criteria and were assigned to the following DxCG risk stratum respectively: healthy 140 (3.9%); 5 (1.1%), stable 263 (7.3%); 17 (3.8%), at risk 661 (18.2%); 71 (15.7%), struggling 1,312 (36.2%); 163 (36.0%), and in crisis 1,249 (34.5%); 197 (43.5%). Stratum distributions were inconsistent between treatment and controls. Sample size for the healthy cohort was too small for analysis. Models by stratum showed remarkable findings for the CM-Complex “at risk” stratum with a significant reduction in annual healthcare expenditures of $5,676. Cost reductions were driven by lower ER and physician office visits. A significant reduction in healthcare expenditures was found when Blue Touch Complex case management (CM-Complex) programs are utilized for at risk patients.