Case Management System Research Articles

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial.

BackgroundWhether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.ObjectiveThe aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.MethodsA multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.ResultsA total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.ConclusionsThis study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

Implementing Case Management within a Large Medicolegal Death Investigation Agency

Medicolegal death investigation agencies must provide timely final autopsy reports in order to meet minimum accreditation standards. To ensure a timely turn around, the principles of case management were introduced into an agency with a large metropolitan jurisdiction. Forensic autopsies are typically complex and the associated ancillary studies often include forensic toxicology along with various specialty consults. Beginning in 2013, a forensic case management service was initiated to aid forensic pathologists in reducing report turnaround time. Despite increasing number of cases in 2014, the agency was able to maintain the accreditation standard of 90% turn around within 90 days. The case management service required process improvement, technology to track and trend, and increased interdisciplinary collaboration. The implementation of a case management system within the forensic autopsy service can improve processes to reduce report turnaround times.

Records management practice: The issues and models for classification

This paper identifies electronic records management practice with particular reference to Syariah Courts in Malaysia specifying on classification matter. Classification is paramount for a complete records management other than safeguarding vital records upon determining their value for business continuity. Prior to that, a number of records management models were analysed with the aim to identify whether the Syariah Courts hold onto a specific model in executing electronic records management. Model generally takes the form of inputs, processes, and outputs or expected results in a simplified representation of a limited part of reality with related elements. The study adopts a survey method with interview and document content analysis as the techniques in analysing the models. The interview served as a snapshot study with the aim to reveal the issues embraced by the e-Syariah systems namely the Syariah Court Case Management System. Upon analysing the existing models, it was discovered there are flaws in the existing models making them inappropriate for implementation as they are too theoretical in nature. Furthermore, none of the models address on records classification. On the other hand, the interviews depicted that the electronic records management carried out in the Syariah Court is without the adoption of any model. It is due to this fact that the system was developed without taking into consideration the classification function but instead was designed for storage and retrieval purposes only.

Use of a Case Management System to Reduce the Response Time for Symptom Management Calls in a High-Volume Practice.

Use of a Case Management System to Reduce the Response Time for Symptom Management Calls in a High-Volume Practice.

Проектный менеджмент в системе государственного управления: проблемы применения

The article deals with the process of modernization of public administration through the introduction of a project management system: defines its role, place and possible application prospects; the main barriers to the introduction and successful implementation of the project management system are identified, including the unwillingness to change and possible risks, the misconception about the system and the results of its application, the imperfection of the legal framework. Also, the problems that require solutions are training of specialists in the field of project management, implementation and use of the software, the complexity of determining the objectives of the project, the effectiveness of its implementation, incorrect distribution of responsibilities.
 The authors suggest ways to create favorable conditions for effective use of the system of project management in the state structure, including improving knowledge of employees, improvement of the legal framework and case management system, management reporting, formation of statistical base for further analysis of project performance and the use of information for more efficient building of further work.

Batch Model for Batched Timestamps Data Analysis with Application to the SSA Disability Program.

The Office of Disability Adjudication and Review (ODAR) is responsible for holding hearings, issuing decisions, and reviewing appeals as part of the Social Security Administration's disability determining process. In order to control and process cases, the ODAR has established a Case Processing and Management System (CPMS) to record management information since December 2003. The CPMS provides a detailed case status history for each case. Due to the large number of appeal requests and limited resources, the number of pending claims at ODAR was over one million cases by March 31, 2015. Our National Institutes of Health (NIH) team collaborated with SSA and developed a Case Status Change Model (CSCM) project to meet the ODAR's urgent need of reducing backlogs and improve hearings and appeals process. One of the key issues in our CSCM project is to estimate the expected service time and its variation for each case status code. The challenge is that the systems recorded job departure times may not be the true job finished times. As the CPMS timestamps data of case status codes showed apparent batch patterns, we proposed a batch model and applied the constrained least squares method to estimate the mean service times and the variances. We also proposed a batch search algorithm to determine the optimal batch partition, as no batch partition was given in the real data. Simulation studies were conducted to evaluate the performance of the proposed methods. Finally, we applied the method to analyze a real CPMS data from ODAR/SSA.

Community Health Workers as Support for Sickle Cell Care.

Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This paper outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of "best practices" for this area of community-based care.

Leverage big data analytics for dynamic informed decisions with advanced case management

Big data is transforming the world, and it’s especially changing the way in which modern enterprises conduct business and strategic, informed decisions. By incorporate big data analysis, organisations can make decisions based on facts rather than intuition or hidden internal knowledge. When decision makers and knowledge workers have access to increasingly accurate and up-to-date trusted source of information, along with the analytical tools to make sense of it, their organisations benefit from more informed decisions and more consistent outcomes than ever before. This approach for supporting decisions can affect overall company’s business and the way knowledge workers do their jobs. Analytic tools took insights from big sets of data. They help broaden the context and background available for making informed, accurate, and consistent decisions. This research renders how Big Data analysis can extend the DSS part of the Adaptive Case Management (ACM) systems. Authors of the article discusses the thesis that by merging analytical tools, flexible process management and access to all required information into a single application - organisations can use big data to help improve the way they do business.

Adaptive design research for the 2020 Census1

The U.S. Census Bureau is researching and testing new methods to reduce the cost of the 2020 Census while maintaining data quality. One of the most costly components of the 2010 Census was Nonresponse Followup. In this operation, enumerators conducted inperson interviews at housing units that did not return a census questionnaire by mail. For the 2010 Census, enumerators were instructed to visit each of these units up to three times until the case was resolved. Additionally, enumerators were to make up to three contact attempts by telephone. In this paper, we present an overview of current research on determining the number of contact attempts that should be made to nonresponding units with an emphasis on cost containment and improved overall productivity. Rather than the fixed contact strategy employed in the 2010 Census, we consider adaptive approaches that maintain the quality of the data. We present initial results of possible approaches using data from the 2010 Census and discuss the implications of the methods. We also discuss modeling contact probabilities for each hour of the day to support the case management system.

A patient-reported outcome driven case management system for hematology/oncology patients.

A patient-reported outcome driven case management system for hematology/oncology patients.

Using Child Well-Being Assessments to Track Progress in Family-Based Reintegration

Retrak, an international non-governmental organization operating in Africa and Latin America, prioritizes family-based reintegration for children living and working on the streets. Retrak has adopted the use of well-being assessments to monitor the progress of each child through their reintegration journey. This paper reflects upon lessons learned by Retrak and explores the challenges and the benefits of developing a body of evidence on reintegration good practice. Children’s well-being assessments have revealed overall improvements during reintegration with some areas such as education and psychosocial well-being being slower to improve. Understanding how well-being changes during reintegration has provided insights to inform program planning and a platform from which to build support for reintegration with donors and policy makers. Recommendations include the need for more organizations to monitor reintegration programs and share results so that methods can be revised and improved. Information gathered through case management systems should be used to ease the monitoring of both changes in children’s lives and the quality and effectiveness of reintegration processes. Weaknesses in gathering data through case management systems can be reduced by clear guidelines and triangulation with different methods.

Utilizing a case management system to reduce the response time for symptom management calls in a high-volume practice.

170 Background: A five physician, three nurse practitioner,community oncology clinic experiences high call volumes (average 352 daily), many of which are related to side-effects of chemo/biotherapy and health related issues. A study was completed to decrease the time for a patient symptom management call to be addressed and concluded. Methods: Initial primary data were collected over a four month period (April-August 2015) using the phone system and the Electronic Health Record (EHR) reporting capabilities, by cross-referencing the caller-ID data with the EHR patient demographics data; only documented symptom management calls within the EHR were included. Twenty-nine percent (202 of 691) of symptom management calls were identified for the sample. Secondary data were collected prospectively using a handwritten call log completed by triage nursing, detailing the purpose of every call routed to triage nursing. Changes were made in the daily telephone call process to include a full-time operator, additional triage nursing staff, and implementation of a structured case management system. Follow-up primary and secondary data were collected for six weeks (August-September 2015) utilizing the case management system. Of the calls routed to triage nursing, 100% were captured in the case management system; call response time and call purpose were recorded. Results: During the initial primary data collection, a baseline of 48% of symptom management calls being addressed within 2 hours was established. Staffing changes resulted in an improvement to 68%, and an additional improvement to 73% after implementation of the case management system. Secondary data collection at baseline showed that 35% of calls were inappropriately routed to triage nursing; this improved to under 1% after implementation of the case management system. Conclusions: The reallocation of staff to concentrate on patient call processes, and the use of a case management system, significantly improved symptom management call response time. The implementation of a case management system nearly eliminated all inappropriate calls routed to triage nursing.

Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions.

Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

Justice Delayed is Justice Denied

Historical acknowledgements of delays in the justice system often recognise the perspective of the accused or the disputant, and suggest that for a person seeking justice, the time taken for resolution of their issue is critical to the justice experience. In essence, these acknowledgements are consistent with more recent research which has shown that the time taken to deal with a dispute is a, and in many cases the, critical factor in determining whether or not people consider that the justice system is just and fair. This article considers issues in the justice system that are related to timeliness and the interconnectedness of the definition of delay and contends that the nature of delay in the current justice environment is contingent on many aspects and mechanisms utilised by the modern justice system. These elements include information technology (‘IT’) and electronic support, proactive intervention and management including case management systems as well as alternative dispute resolution (‘ADR’) for the resolution of civil, family and other disputes. The question of whether justice delayed is justice denied appears to depend on whether delay is inappropriate, out of proportion or avoidable. Proportionality and appropriateness of time taken to provide an outcome for disputants is said to form part of the definition of timeliness, as per the definition above.

Patient-reported outcome driven case management system for hematology and oncology patients.

229 Background: Modern clinical practice places time restrictions on the amount of information and processing that can be done in a typical office visit. Meeting patient needs within the healthcare system is often inefficient and ineffective, contributing to patient and clinician dissatisfaction and suboptimal outcomes. We developed a point-of-care case management system for oncology clinical practices adapted from an algorithm initially designed for patients with diabetes. The system’s goal is to obtain patient-reported quality of life (QOL) outcomes and provide clinicians with information regarding QOL issues to address. Methods: Literature review and focus groups of oncology patients were used to identify key patient concerns. The program was adapted for cancer patients to collect the identified patient concern including QOL, fatigue, pain and other cancer-specific issues scored on a scale of 0-10. Suggested actions and available resources were identified for the patient/clinician based on the issue selected. We performed a pilot study involving 20 cancer patients to assess feasibility, and administered a “was it worth it survey” (WIWI). Results: The resultant hematology/oncology electronic system includes a set of eight primary “buttons”: Personal Relationships, Emotional health, Physical healthy, Cancer diagnosis and treatment, Health behaviors, Money, Care planning and Something else. Every “button” was selected, most commonly Cancer diagnosis and treatment 6/20 (30%). The median (range) reported QOL, fatigue and pain were 7 (1-10), 4 (0-8), 2 (0-8), respectively. The average completion of the tool took 4 minutes. One hundred percent of patients who took the survey thought it was worth it, would participate again and recommend it to others. Conclusions: The system was quick and easy to utilize in a small pilot of patients. All of the identified categories were chosen and relevant to our patient population. This tool has the potential to improve patient well-being and clinical outcomes, reduce the burden on clinicians and distribute case management activities to the most appropriate providers. Next steps include initiating a larger prospective protocol to assess if this tool improves QOL over time.

Case Management and Social Support System for Families in Distress: A Social Work Response

History is witness to the fact that warring factions in any armed conflict often commit several human rights violations like murder, rape, torture etc., and the act of disappearance of person is one among them. While the persons who are subjected to disappearance are the primary victims, the families they leave behind are the secondary victims. The situation makes families of the disappeared person suffer great anguish when their loved ones go disappeared. The phenomenon produces anguish, fear and unspeakable sorrow for thousands of families. Appreciating the importance of social work professionals in helping families deal effective with their life situations the present paper aims to provide a case for social work interventional techniques of Social Support System (SSS) and Case Management to modify and make the social environment conducive for the families to live a normal life.

Cardiovascular Disease in Adolescents and Young Adults with Hematologic Malignancies

Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of survivors of adolescents and young adults (AYA: diagnosed 15-39y) with hematologic malignancies. In the general U.S. population, cardiovascular disease (CVD: heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. While considerable effort has been made to characterize long-term CVD outcomes in survivors of childhood (<21y) cancer, there is a paucity of information on the magnitude and modifiers of CVD risk, as well as outcomes after onset of CVD in survivors of AYA cancers. AYAs diagnosed with hematologic malignancies may be at a higher risk of CVD when compared to the general population because of exposure to cardiotoxic therapies (anthracyclines, radiation), and the development of new CVRFs as they age.Methods: Using a retrospective cohort study design, 779 2+y survivors of non-Hodgkin lymphoma (NHL: N=274), Hodgkin lymphoma (HL: N=323), and acute leukemia (Leuk: N=182), diagnosed at age 15-39y between 1998 to 2009, and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 5-year insurance retention rates for AYA cancer survivors approaching 80% (J Adolesc Young Adult Oncol 2013 2:59). A non-cancer comparison group (N=8,062) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:10) on age at diagnosis, sex, health plan membership and calendar year. Time-dependent Poisson regression was used to derive incidence rate ratio (IRR) estimates and 95% confidence intervals (CI) for CVD (ICD-9 definition: heart failure, stroke, or myocardial infarction), adjusted for relevant covariates. Kaplan-Meier curves were generated for cancer survivors, stratified by CVD status. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per an algorithm developed by KPSC's case management system, which uses a combination of ICD-9 codes, laboratory test results, and documentation of receipt of medications for these conditions (Am J Epidemiol. 2014 179:27).Results: Median age at cancer diagnosis was 29y (range: 15-39 years); 53.4% were male; 58.2% were non-Hispanic white; diagnoses: HL (41.5%), NHL (35.2%), Leuk (23.4%). In cancer survivors, median time from cancer diagnosis to end of follow-up was 5.4y (range: 2-14.9y), representing 4,961 person-years of follow-up. Comparison with non-cancer controls: Multivariable analysis adjusted for age, sex, race/ethnicity, CVRFs, smoking history and overweight/obesity, revealed a significantly increased risk of CVD across all cancer diagnoses (Overall: IRR=3.5, 95%CI, 2.0-6.1) and by certain cancer types (Leuk: IRR=4.5, 95%CI, 1.8-11.2; HL: IRR=3.0, 95%CI, 1.0-8.9; NHL: IRR=2.0, 95%, 0.7-5.6) when compared to non-cancer controls. Modifiers of CVD risk: Hypertension, diabetes, and dyslipidemia were independent modifiers of CVD risk. Hypertension was associated with a 5.1-fold (95%CI, 2.1-12.1) increased risk, diabetes was associated with a 4.4-fold (95%CI, 1.9-9.9) increased risk, and dyslipidemia was associated with a 2.8-fold (95%CI, 1.2-6.6) increased risk of CVD in AYA survivors when compared to survivors without these CVRFs. Outcomes by CVD status among cancer survivors: Overall survival was significantly worse (5y: 64%, 10y: 56%) among cancer survivors who developed CVD when compared to survivors without CVD (5y: 95%, 10y: 91%), p<0.01 (Figure).Conclusions: Survivors of AYA hematologic malignancies are at increased risk for developing cardiovascular disease when compared to a matched non-cancer controls. In these survivors, overall survival following onset of CVD is especially poor, and cardiovascular risk factors are independent modifiers of delayed cardiovascular disease risk. Taken together these data form the basis for identifying high-risk individuals for population-based targeted surveillance, as well as aggressive management of cardiovascular risk factors. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Success Factors for Using Case Management System in Italian Courts

ABSTRACTThis study takes a first step toward understanding the effectiveness of e-court applications in Italy. The proposed research model to assess the success factors for using case management system was tested in two Italian courts. Analysis of survey data from 314 users, using structural equation modeling, reveals the explanatory role of the model and the salient contribution of system and information quality variables on court staff’s performance. Our findings have important implications for theory and practice.

Queueing Models of Case Managers

Many service systems use case managers, servers who are assigned multiple customers and have frequent, repeated interactions with each customer until the customer’s service is completed. Examples may be found in healthcare (emergency department physicians), contact centers (agents handling multiple online chats simultaneously) and social welfare agencies (social workers with multiple clients). We propose a stochastic model of a baseline case-manager system, formulate models that provide performance bounds and stability conditions for the baseline system, and develop two approximations, one of which is based on a two-time-scale approach. Numerical experiments and analysis of the approximations show that increasing case throughput by increasing the probability of case completion can lead to much greater waiting-time reductions than increasing service speed. Many systems place an upper limit on the number of customers simultaneously handled by each case manager. We examine the impact of these caseload limits on waiting time and describe effective, heuristic methods for setting these limits. This paper was accepted by Yossi Aviv, operations management.

Australian mental health staff response to antipsychotic medication side effects – the perceptions of consumers

Despite the impact of side effects on adherence to medication regimes, few previous studies have examined the personal concerns of those prescribed antipsychotic medications. This study explores consumer perceptions of the support they receive from mental health staff for antipsychotic medication side effects. Semi-structured interviews were used to elicit the perceptions of 10 mental health consumers in a community care setting in Australia. Content analysis was used to examine the transcripts, and the audio-recordings were replayed to identify important contextual cues. The analysis identified several main themes, including: the relationship between participants and clinicians; information about side effects; and the value of the case-management system. Most participants reported that health professionals appeared disinterested in the antipsychotic medication side effects they experienced and did not understand the detrimental impact of side effects on their lives. The participants were also not equipped with sufficient information about the care they received, the prescribed medications, and possible side effects. Most participants felt excluded from decisions about the care they received, which caused significant distress. Structures and strategies therefore should be developed to ensure that the views of mental consumers are taken into consideration in a more fulsome manner in delivering mental health care in the community.