Community Case Management Program Research Articles

Impact of a collaborative community case management program on a low-income uninsured population in Sedgwick County, KS

This cross-sectional study assessed the impact of a collaborative nursing/social worker case management (CM) intervention on emergency department (ED) use, health status, and health locus of control (HLOC) in a low-income uninsured population. Using a pre–post intervention design, key outcomes were assessed using paired t test. A statistically significant (48%) reduction in total ED visits resulted in an estimated charge avoidance of US$1,446,280. Physical health status improved significantly; however, mental health status and HLOC scores showed minimal change. This CM model may assist vulnerable groups in gaining access to care and improved health.

Telepharmacy in Mental Health Outpatient Case Management

Objective: To describe the use of videophones to augment community-based case management medical services, particularly for in-home pharmacy consultations. Discussion: Despite recent technologic advances, telepharmacy image applications, in which a patient and a pharmacist can see each other, are rather limited in number and variety. However, videophone technology can fill this role well, given its portability, low cost, reliability, privacy, ease of use, and minimal technologic requirements. Videophone deployment in our psychiatry community case-management program has improved both medical and pharmacist access to a population of seriously mentally ill patients. Specifically, the ability to reach a hospital-based pharmacist through videophone, while making home visits, has allowed clarification of medication preparation and authorization of refills as well as improving treatment adherence. In short, despite minor technical limitations, videophones provide a simple and, in our case, reliable solution for in-home care. To date, both patients and case managers have responded with satisfaction to this treatment adjunct. Conclusions: Despite some limitations, videophone technology can increase patient access to health care, particularly pharmacy consultations. Expanded use of this technology would allow for systematic studies to support or refute the successes documented at our institution.

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

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

Community case management for frail, elderly clients: the nurse case manager's role.

Capitated payment systems have forced healthcare providers to explore new methods of care delivery for frail, older clients who consume a disproportionate amount of time and resources. The authors describe the experiences of frail elders in a community case management program within a managed care setting. The experiences of living with frailty in a changing healthcare system, and perceptions of the case manager's ability to help navigate that system, are described. This article presents the benefits of community case management toward client goals of safety, support, and control.

Evaluation of cost and hospitalization outcomes from a community case management program serving heart failure clients

Evaluation of cost and hospitalization outcomes from a community case management program serving heart failure clients

A Comparison of Hospital and Community Case Management Programs for Persons With AIDS

To determine whether locus of AIDS case management affects the content of this service, a survey of case managers in 42 major American cities was conducted. One hundred seventy-one case managers working in both public hospitals and community-based organizations (CBOs) responded. Hospital case managers were substantially more likely to report clinical training than CBO case managers. Hospital case managers' case loads were more likely to include drug users and patients with more urgent needs such as housing and drug abuse treatment. While CBO case managers were more likely to work to develop services in the community, hospital case managers reported working more closely with medical staff and discharge planning committees. CBO case managers reported greater difficulty obtaining a number of key services for their clients including home health care, housekeeping, and entitlements; hospital case managers reported greater difficulty obtaining emotional support volunteers. These results indicate that locus of case management strongly affects the structure and content of this service. The importance of these findings for future program planning is discussed.