Community-based Case Management Research Articles

The Role of Certified Community Behavioral Health Centers in Improving Access to Peer-Supported Services.

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization's transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model.

Utilization of integrated community-based case management of childhood illness and associated factors in Ethiopia: a systematic review and meta-analysis

BackgroundDespite significant progress being made in reducing under-five mortality, three-fourths of under-five deaths are still caused by preventable conditions such as pneumonia, diarrhea, malaria, and newborn issues. Integrated community case management of childhood illnesses (ICCM) could serve as a means to reduce preventable child mortality in Low- and Middle-Income countries. Our aim was to assess the overall level of ICCM utilization and its associated factors in Ethiopia.MethodsCandidate studies for inclusion in this review were identified through searches across various databases, including PubMed, EMBASE, Google Scholar, and university repositories online databases, spanning from February 1, 2024, to March 18, 2024. The quality assessment of the studies included in this systematic review and meta-analysis was conducted using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data extraction and analysis were carried out using Microsoft Excel and Stata 17 software, respectively. Heterogeneity among the studies was assessed using Cochran’s Q test and I2 statistics, while the presence of publication bias was evaluated through funnel plots and Egger’s regression asymmetry test. Subgroup analysis was performed based on sample size and study site.ResultsIn this study, the pooled level of ICCM utilization was found to be 42.73 (95%, CI 27.65%, 57.80%) based on the evidence obtained from ten primary studies. In this review, parents’ awareness about illness (OR = 2.77, 95%, CI 2.06, 3.74), awareness about ICCM service (OR = 3.64, 95%, CI 2.16, 6.14), perceived severity of the disease (OR = 3.14, 95%, CI 2.33, 4.23), secondary/above level of education (OR = 2.57, 95%, CI 1.39, 4.77), and live within 30 min distance to the health post (OR = 3.93, 95%, CI 2.30, 6.74) were variables significantly associated with utilization of ICCM in Ethiopia.ConclusionThe utilization of ICCM was found to be low in Ethiopia. Factors such as parents’ awareness about the illness, knowledge of ICCM services, perceived severity of the disease, attending a secondary or more level of education, and living within 30 min distance to the health post were significantly associated with the utilization of ICCM. Therefore, it is crucial to focus on creating awareness and improving access to high-quality ICCM services to reduce child morbidity and mortality from preventable causes.

Self-Reported Mental Health and Addiction Outcomes of a Novel Community-Based Case Management Program for Frequent Emergency Department Users

Frequent emergency department users with mental illness or addiction often struggle to find the services they need. A pre-test/post-test design assessed outcomes for these individuals after participating in a novel community-based stepped-care program delivering individualized intensive case management services. Results indicated improvement in overall functioning and severity of anxious and depressive symptoms.

Mitigating the Violence of Mass Immigration Detention Through Community-Based Case Management

Immigration detention causes psychological, physiological, and financial harm, primarily to noncitizens of color. Following a mass release of “lower-priority" individuals, responses to the COVID-19 pandemic provide an opportunity to envision a system more focused on freedom and pragmatism rather than retributive and ineffective notions of human warehousing and deterrence. Utilizing community-based case management (CBCM), a majority of detained noncitizens could be immediately returned to their families and communities under agency discretion. While some alternatives to incarceration serve as extensions of the carceral state, CBCM maintains required court appearances and preserves occupational and familial obligations at a fraction of detention costs without the need for intensive surveillance or restrictions. Drawing upon available research, theories of violence, and strengths-based case management, this article critically examines the emergence of mass immigration detention in the United States and considers a noncarceral approach to mitigate such state violence against detained noncitizens, as well as their families and communities. The profession of social work is uniquely positioned to implement CBCM to address the mass detention crisis and the grand challenge of smart decarceration. Social workers are well-equipped to 1) advocate for sensible decarceration policy, 2) conduct action-oriented scholarly research on the impacts of detention and outcomes of CBCM, and 3) provide integrated case management for noncitizens in immigration removal proceedings.

Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul.

To overcome the limited effectiveness of standard case management services, the Seoul Intensive Case Management program (S-ICM) for patients with serious mental illnesses was introduced in 2017. This study aimed to evaluate its effectiveness in reducing the length of hospital stay. Monitoring data from April 2019 to March 2020 were retrieved from the Seoul Mental Health Welfare Center. A total of 759 participants with serious mental illnesses were included. The average length of admission per month was compared between the pre-ICM (previous year) and during-ICM periods. For post-ICM observation subgroup, average length of admission per month was compared between pre-ICM, during-ICM, and post-ICM periods. To determine the relative contributions of risk factors for during-ICM and post-ICM admission, multivariate logistic regression analyses were performed. The average admission stay for pre-ICM period was significantly longer than that for during-ICM period (1.47 vs. 0.26 days). Among the predictors for during-ICM admission, pre-ICM psychiatric admission was the most important risk factor, followed by medical aid beneficiary and suicidal behavior. In the subgroup analysis of the post-ICM observation period, the pre-ICM, during-ICM, and post-ICM average admission stays were 1.45, 0.29, and 0.57 days/month, respectively. There was a significant difference in the average length of stay between the pre-ICM and during-ICM periods and between the pre-ICM and post-ICM periods. Post-ICM admission risks included pre-ICM admission, S-ICM duration <3 months, and chronic unstable symptoms. The results suggest that the S-ICM effectively reduces psychiatric hospitalization duration, at least over a short-term period.

Development and User Testing of a Dynamic Tool for Rheumatic Heart Disease Management.

Most rheumatic heart disease (RHD) registries are static and centralized, collecting epidemiological and clinical data without providing tools to improve care. We developed a dynamic cloud-based RHD case management application with the goal of improving care for patients with RHD in Uganda. The Active Community Case Management Tool (ACT) was designed to improve community-based case management for chronic disease, with RHD as the first test case. Global and local partner consultation informed selection of critical data fields and prioritization of application functionality. Multiple stages of review and revision culminated in user testing of the application at the Uganda Heart Institute. Global and local partners provided feedback of the application via survey and interview. The application was well received, and top considerations included avenues to import existing patient data, considering a minimum data entry form, and performing a situation assessment to tailor ACT to the health system setup for each new country. Test users completed a postuse survey. Responses were favorable regarding ease of use, desire to use the application in regular practice, and ability of the application to improve RHD care in Uganda. Concerns included appropriate technical skills and supports and potential disruption of workflow. Creating the ACT application was a dynamic process, incorporating iterative feedback from local and global partners. Results of the user testing will help refine and optimize the application. The ACT application showed potential for utility and integration into existing care models in Uganda.

Evaluating barriers and facilitators to healthcare providers’ use of an emergency department electronic referral portal for high-risk children with asthma using the Theoretical Domains Framework

Objective Urban children with asthma are at risk for frequent emergency department (ED) visits and suboptimal asthma management. ED visits provide an opportunity for referrals to community-based asthma management services. Electronic medical record-based referral portals have been shown to improve quality of care but use of these portals by healthcare providers (HCPs) is variable. The purpose of the study was to investigate facilitators, barriers, and recommendations to improve the use of an electronic referral portal to connect children presenting with asthma exacerbations in an urban pediatric ED to community-based education and case management services. Methods The study was grounded in the Theoretical Domains Framework, an implementation provided the theoretical basis of the study. All ED HCPs were invited to complete qualitative interviews; twenty-three HCPs participated. Interviews were coded using directed content analysis. Results Facilitators to portal use included its relative ease of use and HCP beliefs regarding the importance of such referrals for preventive asthma care. Barriers included insufficient time to make referrals, lack of information regarding the community agency and challenges communicating the value of the referral to patients and/or their caregivers. Conclusions Successfully engaging HCPs working in ED settings to use electronic portals to refer children with asthma to community agencies for health services may involve helping providers increase their comfort and knowledge of the external provider agency, ensuring organizational leaders support the need for preventive asthma care and provision of feedback to HCPs on the success of such referrals in meeting the needs of those families served.

Protecting Your Professional Practice.

Lynn S. Muller, JD, BA-HCM, RN, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her bachelor of arts degree in health care management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the contributing editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the board of directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP Programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and third edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a certified facilitator for CCM CERTIFCATION 360, a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past President of the New Jersey Chapter of CMSA. Dr. Muller is the former director of social services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman, and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by email at: [email protected]. If you have an idea you would like to discuss, send your contact information by email and you will be contacted via your preferred method. The author reports no conflicts of interest.

Lessons Learned From a Veteran's Perspective.

Lynn S. Muller, JD, RN, BA-HCM, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her Bachelor of Arts degree in Health Care Management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the Contributing Editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the Board of Directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and 3rd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a Certified Facilitator for CCM CERTIFCATION 360 a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past president of the New Jersey Chapter of CMSA. Dr. Muller is the former Director of Social Services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, RN, BA-HCM, CCM, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). You are Invited to share your knowledge and experience. Do you have a question or issue you would like to see addressed here? Questions are always welcome. We encourage and invite all readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. If you have an idea, you would like to discuss, or are considering being a first-time author, send your contact information by email and you will be contacted via your preferred method. All inquiries and submissions are accepted by email at [email protected] Case Management Matters welcomes and invites you to submit articles, stories, practice tips, reflections, and revelations. We encourage new/first-time authors and will work with you. How has case management changed you and/or how have you affected the lives of others? All inquiries, questions, comments, and manuscripts should be submitted via email to [email protected] or by mail to Lynn S. Muller, P.O. Box 164, Bergenfield, NJ 07621-0164. If you have an idea for an article, but would like to discuss it, provide contact information in your email and you will be contacted by your preferred method. The author reports no conflicts. The author reports no conflicts of interest.

A legal dispute resolution intervention for patients with substance use disorders: a study protocol for a randomized controlled trial

BackgroundSubstance use disorders (SUDs) represent major public health concerns and are linked to enhanced risk of legal consequences. Unresolved legal issues may prevent individuals with SUD from completing treatment. Interventions aimed at improving SUD treatment outcomes are limited. Filling that gap, this randomized controlled trial (RCT) tests the ability of a technology-assisted intervention to increase SUD treatment completion rates and improve post-treatment health, economic, justice-system, and housing outcomes.MethodsA randomized controlled trial with a two-year administrative follow-up period will be conducted. Eight hundred Medicaid eligible and uninsured adults receiving SUD treatment will be recruited at community-based non-profit health care clinics in Southeast, Michigan, USA. Using an algorithm embedded in a community-based case management system, we randomly assign all eligible adults to one of two groups. The treatment/intervention group will receive hands-on assistance with a technology aimed at resolving unaddressed legal issues and the control group receives no treatment. Upon enrollment into the intervention, both treatment (n = 400) and control groups (n = 400) retain traditional options to resolve unaddressed legal issues, such as hiring an attorney, but only the treatment group is targeted the technology and offered personalized assistance in navigating the online legal platform. To develop baseline and historical contexts for participants, we collect life course history reports from all participants and intend to link those in each group to administrative data sources. In addition to the randomized controlled trial (RCT), we used an exploratory sequential mixed methods and participatory-based design to develop, test, and administer our life course history instruments to all participants. The primary objective is to test whether targeting no-cost online legal resources to those experiencing SUD improves their long-term recovery and decreases negative health, economic, justice-system, and housing outcomes.DiscussionFindings from this RCT will improve our understanding of the acute socio-legal needs faced by those experiencing SUD and provide recommendations to help target resources toward the areas that best support long-term recovery. The public health impact includes making publicly available a deidentified, longitudinal dataset of uninsured and Medicaid eligible clients in treatment for SUD. Data include an overrepresentation of understudied groups including African American and American Indian Alaska Native persons documented to experience heightened risk for SUD-related premature mortality and justice-system involvement. Within these data, several intended outcome measures can inform the health policy landscape: (1) health, including substance use, disability, mental health diagnosis, and mortality; (2) financial health, including employment, earnings, public assistance receipt, and financial obligations to the state; (3) justice-system involvement, including civil and criminal legal system encounters; (4) housing, including homelessness, household composition, and homeownership.Trial registrationRetrospectively registered # NCT05665179 on December 27, 2022.

The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship.

Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.

Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study.

This longitudinal study aimed to evaluate a community-based and nurse-led advanced case management model centered on disease management. Participants were chronically ill patients aged 20 years and older who were highly dependent on medical care. The case management group (CMG) received nurse-led advanced case management, and the comparison group (CG) was selected by matching estimated propensity scores with the CMG. We compared the changes in medico-economic indicators between the two groups and analyzed the physical and psychological indicators of the CMG over time. The CMG comprised 51 participants, of which eight dropped out by 12 months after registration. After 1:1 propensity score matching, there were 40 participants in the CMG and CG, respectively. At 12 months after the registration, there was no significant difference between the two groups and no change in the CMG. At 24 months after the registration, the CMG’s medical and long-term care costs decreased significantly, while the CG’s costs increased. Moreover, there was a significant reduction in the number of hospital days and hospital admissions in the CMG. Our findings revealed that nurse-led advanced case management could be useful for patients with complex needs to avoid hospitalization due to exacerbations.

Received Social Support Scale for Persons with Serious Mental Illness: Preliminary scale development and validation study.

This study investigated the psychometric properties of a newly developed Received Social Support Scale for Persons with Serious Mental Illness (rSSS-SMI). The rSSS-SMI measures three support domains: Day-to-Day Living support, Mental Health Support, and Adherence Support. (a) to examine the item quality of the rSSS-SMI, (b) to investigate the construct validity and verify the dimensionality of the rSSS-SMI, and (c) to investigate the reliability and validity of the rSSS-SMI scores. A sample of 267 community-based case management service recipients with SMI completed the rSSS-SMI and three additional scales (Interpersonal Support Evaluation List-Short Form [ISEL-12]; Symptom Checklist-6 [SCL-6]; Satisfaction with Life Scale [SWLS]). Three items were dropped from the scale resulting in a 21-item scale. Confirmatory factor analysis and Item Response Theory analyses revealed our proposed three-factor model fit the data best, with average loadings at .74 (SD = .09). The three-factor model had higher item discrimination and item difficulty parameters than the one-factor model. The rSSS-SMI achieved strong internal consistency with estimates of .94 (full scale), .83 (Day-to-Day Living Support), .84 (Mental Health Support) and .76 (Adherence Support). The three-week interval test-retest reliability coefficient was .59. Convergent and discriminant validity evidence revealed a small, positive correlation between the rSSS-SMI and perceived support (ISEL-12) and symptom distress (SCL-6) and a small, negative, nonsignificant relationship with life satisfaction (SWLS). This study provides preliminary reliability and validity evidence for the rSSS-SMI and confirms our proposed three-factor structure (Day-to-Day Living Support, Mental Health Support, Adherence Support). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives

IntroductionHomelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness.MethodsThis qualitative study is part of a larger mixed‐methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless—Financial Incentives [CATCH‐FI]) within a community‐based brief case management programme (CATCH) in Toronto, Ontario. Twenty‐two CATCH‐FI participants were purposefully recruited to participate in in‐depth, semi‐structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio‐recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well‐being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member‐checking enhanced the analytical rigour and validity of findings.ResultsCATCH service providers, key informants and subgroup of CATCH‐FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH‐FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well‐being in enabling access to basic needs and simple pleasures.ConclusionsOur data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well‐being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population.Patient or Public ContributionStudy participants provided input into the study research questions, study design, interview guides and interpretation of findings.

Demand for community-based Case Management in Austria - a qualitative analysis

BackgroundThe number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs.MethodsA qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis.ResultsThe analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers.ConclusionsCare institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers.

BackgroundMachine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied.ObjectiveThis study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations.MethodsParticipants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways.ResultsCase managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity.ConclusionsSuicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.

Experiences of Community-based Case Management for Early Psychosis: Focusing on Social Treatment for Early Psychosis (STEP) Program

Purpose The purpose of this study was to explore the experience of case management for early psychosis and identify factors influencing care management. Methods We conducted in-depth interviews with 10 mental health professionals who implemented the Social Treatment for Early Psychosis (STEP) program. The collected data were analyzed using qualitative content analysis. Results The findings consisted of 4 categories and 15 subcategories. Case management should develop expertise considering the desires of young adults, and grew as experts by promoting family cooperation and coping with mental crises. Administrator's support and peer support programs had a positive impact, while the absence of collaborative systems with psychiatric institution were identified as limitations in the operating system of the basic center. Consulting and monitoring of the metropolitan center provided a foundation for case management at the basic center, while the government's support policy is needed to improve of working environment and set up the youth-friendly early intervention system. Conclusion The results suggest that case management for early psychosis requires multilateral and cooperative efforts by strengthening the capabilities of case managers, establishing an integrated case management network of basic and metropolitan centers, and expanding the government's human and physical infrastructure. Key words: Case management; Community mental health services; Early psychosis; Qualitative research 주요어: ì¡°ê¸°ì •ì‹ ì¦, 사례관리, ì§€ì—­ì‚¬íšŒì •ì‹ ê±´ê°•ì„œë¹„ìŠ¤, ì§ˆì ì—°êµ¬

Implementation of nursing case management to improve community access to care: A scoping review.

Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings. This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications. This study was conducted following the framework of scoping review. The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included. The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result. A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training. Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses' advocacy competence for future implications.

Predictive Model-Driven Hotspotting to Decrease Emergency Department Visits: a Randomized Controlled Trial.

Emergency department (ED) visits contribute substantially to health care expenditures. Case management has been proposed as a strategy to address the medical and social needs of complex patients. However, strong research designs to evaluate the effectiveness of such interventions are limited. To evaluate whether a community-based case management program was associated with reduced ED utilization among complex patients. Patients whose risk exceeded a threshold were randomly assigned to a group offered case management or to the control group. Assignment occurred at five intervals between November 2017 and January 2019. Program effectiveness for all assigned patients was assessed using an intention-to-treat effect. Program effectiveness among those who received treatment was assessed using a local average treatment effect, estimated using instrumental variables. Both estimators were adjusted for baseline characteristics using linear models. Adults over age 18 with at least one health care encounter with Michigan Medicine or St. Joseph Mercy Health System between June 2, 2016, and November 27, 2018. Intervention arm participants (n = 486) were offered coordinated case management across medical, mental health, and social service organizations. Control arm participants (n = 409) received usual care. The primary outcome was the number of ED visits in the 6 months following randomization into the study. Secondary outcomes were 6-month counts of inpatient and outpatient visits. Of the 486 patients assigned to the intervention, 131 (27%) consented to receive case management. The intention-to-treat effect on ED visits was + 0.14 (95% CI: - 0.27 to + 0.55). The local average treatment effect among those who consented and received case management was + 0.53 (95% CI: - 1.00 to + 2.05). Intention-to-treat and local average treatment effects were not significant for secondary outcomes. The community case management intervention targeting ED visits was not associated with reduced utilization. Future case management interventions may benefit from additional patient engagement strategies and longer evaluation time periods. Clinicaltrials.gov Identifier: NCT03293160.

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities - Benton and Washington Counties, Arkansas, March-June 2020.

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.