Health Care Case Management Research Articles

Primary Health Care Case-Management Nurses during the COVID-19 Pandemic: A Qualitative Study.

The COVID-19 has caused high morbidity and mortality in vulnerable people, such as those affected by chronic diseases, and case-management nurses (CMNs) are reference professionals for their health care and management. The objective of this study is to better understand the discourse, experiences, and feelings about the professional performance of CMNs during the pandemic. A qualitative study was conducted by conducting semi-structured interviews with CMNs (n = 31) from the province of Seville (Spain) and performing a narrative discourse analysis. The Atlas Ti 6.2 software program was used. Two categories were defined: 1. CMNs' competencies (76 verbatim testimonies); and 2. Consequences of the COVID-19 pandemic (61 verbatim testimonies). This study was granted due permission by the Research Ethics Committee belonging to the University of Seville, under protocol code: 1139-N-22. The pandemic caused an increase in CMNs' workload, and they had to assume their usual care tasks for vulnerable populations in addition to simultaneously prioritizing assistance in nursing homes. We can highlight CMNs' adaptation to the pandemic situation and to these new requirements in the context of their significant social commitment to the advanced practice of the profession, a commitment that is closely related to leadership. We should also indicate that interpersonal relationships were improved, and that there was technological progress. Some CMNs mentioned an increase in their workload and reported experiencing burnout syndrome. We conclude that CMNs' management of health care during the pandemic has been extraordinary, especially in regard to the most vulnerable populations of patients, including individuals with chronic diseases and institutionalized older adults, a fact that has been valued by the institutions and by society in general.

Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles

BackgroundAdvances in systems science creates an opportunity to bring a complexity perspective to health care practices and research. While medical knowledge has greatly progressed using a reductionist and mechanistic philosophy, this approach may be limited in its capacity to manage chronic and complex illness. With its holistic foundation, naturopathy is a primary health profession with a purported alignment with a complexity perspective. As such this pilot study aimed to investigate the application of complexity science principles, strategies, and tools to primary health care using naturopathy as a case study.MethodsA network mapping and analysis of the naturopathic case management process was conducted. Mind maps were created by naturopathic practitioners to reflect their clinical conceptualisation of a common paper clinical case. These mind maps were inputed into Gephi, a network mapping, exploration, and analysis software. Various layouts of the data were produced, and these were analysed using exploratory data analysis and computational network analysis.ResultsSeven naturopathic practitioners participated in the study. In the combined network mapping, 133 unique elements and 399 links were identified. Obesity, the presenting issue in the case, was centrally located. Along with obesity, other keystone elements included: systemic inflammation, dysbiosis, diet, the liver, and mood. Each element was connected on average to 3.05 other elements, with a degree variation between one and 36. Six communities within the dataset were identified, comprising: the nervous system and mood, gastroinstetinal and dietary factors, systemic inflammation and obesity, the endocrine system and metabolism.ConclusionsThis pilot study demonstrates that it is feasible to apply a complexity science perspective to investigating primary health care case management. This supports a shift to viewing the human organism as a complex adaptive system within primary health care settings, with implications for health care practices that are more cognisant with the treatment of chronic and complex conditions and research opportunities to capture the complex clinical reasoning processes of practitioners.

Cognitive Impairment and Glycemic Control in Elderly Patients Under Health-Care Case Management.

We aim to test whether the association between glucose control and cognitive function still holds true in elderly patients with diabetes mellitus (DM) and Alzheimer disease (AD) under health-care case management. We enrolled 100 patients with DM (mean age: 74.6 years; male: 49%) and 102 patients with AD (mean age: 77.9 years; male: 41.2%) consecutively from the Diabetes Shared Care Program and the memory clinic. These patients were followed up every 3 months with scheduled examinations. Most patients with AD were at early stage and DM was a common comorbidity (n = 42). In the DM group, there were 76 patients with subjective cognitive decline and 19 patients with mild cognitive impairment, but none sought further consultation. After adjusting for age, sex, education, and comorbidity, higher levels of glycated hemoglobin (HbA1C) were not associated with lower Mini-Mental State Examination (MMSE) scores in the DM group (coefficient: 0.03; 95% confidence interval [CI]: -0.44 to 0.50) and lower MMSE scores were not associated with higher HbA1C in the AD group either (coefficient: -0.05; 95% CI: -0.11 to 0.01). When additionally accounting for the variability of HbA1C in the DM group, higher standard deviation of HbA1C was associated with poor clock drawing test scores, but not MMSE. The coexistence of AD-DM was common, but the association between hyperglycemia and cognitive impairment was not seen in patients under regular health monitoring.

Empowerment of Home Health Care Case Managers

Empowerment of Home Health Care Case Managers

On the evolution of process-oriented approaches for healthcare workflows

In the healthcare domain, a wide range of processes with different characteristics and requirements are executed, ranging from highly standardised procedures to less structured ones that reflect the knowledge-intensive nature of clinical decision making. Healthcare is thus widely recognised as one of the most promising, yet challenging, domains for the adoption of process-oriented models and solutions able to support organisational and clinical processes. In this paper, we provide an up-to-date overview that presents and discusses the application of process-oriented solutions in the healthcare domain. Our analysis covers both administrative/organisational processes and medical processes, and we consider contributions and research efforts produced by the business process management (BPM) community and the medical informatics community. We delineate the overall evolution that has been observed from imperative and activity-centric approaches to the emergence of declarative data-centric methodologies, including the recent trends towards adaptive case management in healthcare.

An Integrative Review of Case Management for Diabetes

The purpose of this integrative review is to examine the effectiveness of case management for improving health outcomes in patients with diabetes mellitus as found in the literature from 2000 to 2010. Diabetes case management in health care settings. Case management is an effective intervention for glycemic control and is cost-effective. Evidence is building for its use in primary care. Case management can be an important intervention for diabetes care in primary care and community settings. With evidence at the level of rigor of randomized controlled trials, case management significantly improved biophysiological, psychosocial, preventive, and adherence outcomes. Thus, case management can be an important aspect of effectiveness in health care services delivery within a reconfigured delivery system.

2. Case Management in Health Care

2. Case Management in Health Care

Case Management in Healthcare: A Practical Guide

Case Management in Healthcare: A Practical Guide

CVA2 Cost-Effectiveness and Economic Efficiency: The Case of Statin Therapy in Secondary Prevention of Cornary Heart Disease

Health-care case management places pressure on decision makers to adopt treatment strategies that promote economic efficiency and hence profitability. Traditional costeffectiveness analysis (CEA), where the objective is to calculate cost-effectiveness ratios, can better inform decision making in markets where prices and efficacy vary widely. However, the threshold at which a given therapy becomes economically efficient relative to competing therapies is not evident from cost-effictiveness ratios alone. OBJECTIVE: To illustrate the use of spatial techniques for identifying efficient treatment options, using statin therapy in secondary prevention of coronary heart disease (CHD) as a case study. METHODS: We used a Markov model of CHD epidemiology and treatment to estimate cost-effectivness of 13 statin regimens versus no therapy in secondary prevention of CHD. Comparative efficacy was assessed using data from a recent trial (CURVES) that included these regimens. Patients were assumed to have a history of CHD with risk factors similar to those observed in the trial. CHD event risk was estimated using new subsequent-event risk equations from the Framingham Heart Study. Effectiveness was measured alternatively as gain in life expectancy and CHD events averted. RESULTS: At usual starting doses, atorvastatin therapy provided the largest life expectancy gain and CHD event avoidance at the lowest cost per life-year gained ($12,900 and $23,400 for men and women, respectively), followed by simvastatin ($17,700 and $31,700), lovastatin ($18,800 and $33,700), pravastatin ($22,600 and $40,200), and fluvastatin ($23,800 and $42,000). Any desired level of effectiveness can be obtained at lowest cost with atorvastatin. CONCLUSION: Economic efficiency is enhanced when atorvastatin is used to treat some or all patients requiring statin therapy in secondary prevention of CHD.

The pediatrician and the child in foster care.

Caring for children in foster care, as for any child who has complex issues, is challenging and sometimes daunting. The pediatrician should become familiar with the intricacies of foster care agencies and the consent and confidentiality issues for children in dependent care. While maintaining communication with the social services agency, the physician should assume the responsibility for health care case management to promote regular comprehensive preventive health care; to ensure that children in foster care have access to all necessary services; and to optimize the physical, emotional, developmental, and mental health status of children placed into dependent care.

Case management in health care.

Case management in health care currently is increasing as a result of intentions to lower or control health care costs and to facilitate client access to services. The author examines case management, identifies the issues that it raises for social workers, and discusses case management trends. Several strategic actions that social workers can take in response to this expanding form of health care delivery also are proposed.