Implementation Of Case Management Research Articles

Streamlining patient flow and enhancing operational efficiency through case management implementation

BackgroundImproving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary...

Case management as a tool for integrated care

Introduction: Résinam and Chronicopôle are two pilot projects implemented in the Namur and Liège areas. They are part of a larger plan of 12 integrated care initiatives targeting chronically ill people. The “Case management” is a central action within the two pilot projects. Its main specificity is that it meets with a number of components of integrated care as well as needs arising from the field experience.
 Policy Context And Objective: Each territory has its own specificities. For example, we can identify home nursing coordination, integrated home care services, P3 protocols... The “case manager” is not an additional initiative. He/She intervenes up when the missions of the different structures do not allow a sufficient offer of care to the patient. His/Her intervention is therefore ad hoc and characterized by a period of crisis. His/Her main objective is to stabilize patient care while offering a treatment path that corresponds with their needs. His/Her intervention requires acting in coherence with the operating mode of the network. He/She must be able to target his/her strengths and limits of action in order to adapt his/her missions. 
 Target population: Chronically ill people in a situation of polyfragility (mental health problem and/or social insecurity)
 Highlights (innovation, impact, outcomes): The implementation of case management has been evolving (since 2018, 3 case managers have taken care of 171 patients in the Namur region) according to the specificities of the areas and to the projects that have developed the mission. 
 Nethertheless, we can identify a common process to facilitate the development of this action. It is necessary to co-construct the profile with the various stakeholders (in Namur, a working group with home care coordination and a Be-Hive researcher has been set up) in order to identify the existing processes and the unmet needs among patients.
 On the other hand, we can mention an added value for the patient namely the reactivation of available services, the networking of the various stakeholders (which goes beyond simple multidisciplinary consultation). This approach invites social interventions (CPAS, humanitarian aid centers and the social and housing services) to interact, focusing on the patient and his health.
 Conclusion: The implementation process as described is an added value in terms of change management. The action highlights the different processes of patient care and allows an improvement of the situations encountered in the most complex situations. This process requires flexibility from stakeholders and openness in terms of integrated care.
 The process of network activation and patient support requires stakeholders to be open in the process and innovative in the segmentation of services to provide quality outpatient service.
 The outpatient service also allows to work from the patient’s perspective, using communication tools that allow case managers and protagonists to work on requests while respecting the person's choice.
 This co-construction system allows the needs of each stakeholder (subsidizing power-service providers-patients) to be met and is therefore a reference as a methodology for implementing other integrated care initiatives.

Case management as an opportunity for healthcare: user experiences

Introduction: People with multimorbidity and their caregivers are beginning to be recognized as emerging subjects of health systems. In Colombia there is no differentiated approach to care for this population, as well as its health-disease process. Objective: To understand the experience of people with multimorbidity and their caregivers after receiving a case management intervention. Methods and materials: It is a qualitative study in which 33 participants among people with multimorbidity and their caregivers who received intervention with case managers were interviewed, a comparative analysis and use to tools analytics grounded theory. Results: There are 3 dimensions that are, the actors where nursing becomes relevant as a reliable source of care; the Care Meeting, as a space created within case management to maintain trust and; Results in the health system, where the need to integrate this type of outbreak into the Colombian Health Model is confirmed. Discussion: Complementary qualitative evidence data from the central study with a greater impact on the quality of care through the therapeutic relationship at home. Conclusion: The dyad requires home support for self-management of the disease based on trust, empathy, empowerment and administrative management carried out by case managers.

More Talk, Less Conflict: Evidence from Requiring Informal Discovery Conferences

Abstract Discovery is the formal process of exchanging information under the supervision of the courts. Since managing discovery is costly, courts have implemented case management techniques to reduce motion practice in discovery. This study examines whether case management techniques can reduce the likelihood of a discovery dispute. We attempt to untangle the impact of specific judges from the use of a particular case management technique. We focus on the use of informal discovery conferences (IDCs) in which parties meet with the judge before filing a motion to compel. The problem with simply testing whether IDCs reduce the number of discovery motions is that the use of an IDC is likely endogenous. Our solution to this endogeneity is to use the random assignment of judges. Since some judges have a higher propensity to use IDCs and some courts have begun requiring them, we have two sources of policy variation. Using this estimation strategy, we find that IDCs reduce the number and presence of discovery motions. (JEL K13, K40, K41)

An Assessment of Case Manager Experience on the Implementation of Case Management at Langsa City General Hospitals

Background: The responsibility of case managers is to facilitate and coordinate patient care. Their presence in the implementation of case management is expected to have a beneficial impact. The program is also expected to benefit the hospital in a variety of ways, specifically in terms of patient service management related to more cost-effective services. Objective: This research aims to explore the experience of case managers in carrying out case management at Langsa City General Hospital (RSUD), which has been operational since June 2019. Methods: This research adopted a qualitative design with a descriptive phenomenological approach. From a total of seven individuals on duty, five case managers from the nursing profession were included in the population. The remaining two are medical professionals and refused to participate. Data were collected by conducting interviews, observations, and documentation. Results: The results showed that case managers are still in the honeymoon phase, with their services focused on the collaboration gap and overlapping roles. Conclusion: Almost all case managers feel that their work experience has not been fully implemented in accordance with the work program. They have to adapt to new tasks and receive some training related to the implementation of case management in hospitals.

Scoping Review: The Role of Personal Resilience and Personality Traits of Health Professionals In The Implementation of Interprofessional Collaboration Practice In Hospital

Health workers have a major role in increasing public satisfaction and assessing the quality of hospital health services. To answer and get this, hospitals must pass the accreditation stage through the hospital accreditation committee, namely by having criteria for the National Hospital Accreditation Standard is Interprofessional Collaboration (IPCP) but challenges between fellow professions and from themselves because there is still autonomy from each profession. Autonomy is also a coping method health professionals use to overcome challenges. The purpose is to examine the role of personal resilience and personality traits of health professionals in IPCP implementation in hospitals. A scoping review was conducted according to PRISMA guidelines for a scoping review. The study was performed on six databases (PubMed, Clinical Key, ProQuest, EBSCO, Scopus, and Science Direct) for relevant papers published between 2017 and 2021. Search terms included "Resilience AND Personality, "Health Professionals", "Interprofessional Collaboration Practice", AND "Hospital." Eight articles were included in this review. The study showed that personal resilience and personality traits determined the success of IPCP implementation in the hospital, which was influenced by education, training, management support, and hospital facilities and infrastructure. Conclusion: The role of each health professional's personal resilience and personality traits affects the quality of IPCP implementation in the hospital. Recommendation: IPCP can improve the quality of service in hospitals by facilitating health professional knowledge and skills about interprofessional collaboration, especially in implementing case management in hospitals.

Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study.

In many hospitals, a discharge planning team works with the medical team to provide case management to ensure high-quality patient care and improve continuity of care from the hospital to the community. However, a large-scale database analysis of the effectiveness of overall discharge planning efforts is lacking. This study was designed to investigate the clinical factors that impact the efficacy of discharge planning in terms of hospital length of stay, readmission rate, and survival status. A retrospective study was conducted based on patient medical records and the discharge plans applied to patients hospitalized in a regional medical center between 2017 and 2018. The medical information system database and the care service management information system maintained by the Ministry of Health and Welfare were used to collect data and explore patients' medical care and follow-up status. Clinical factors such as activities of daily living ≤ 60, having indwelling catheters, having poor control of chronic diseases, and insufficient caregiver capacity were found to be associated with longer hospitalization stays. In addition, men and those with indwelling catheters were found to have a higher risk of readmission within 30 days of discharge. Moreover, significantly higher mortality was found after discharge in men, those ≥ 75 years old, those with activities of daily living ≤ 60, those with indwelling catheters, those with pressure ulcers or unclean wounds, those with financial problems, those with caregivers with insufficient capacity, and those readmitted 14-30 days after discharge. The findings of this study indicate that implementing case management for discharge planning does not substantially reduce the length of hospital stay nor does it affect patients' readmission status or prognosis after discharge. However, age, underlying comorbidities, and specific disease factors decrease the efficacy of discharge planning. Therefore, active discharge planning interventions should be provided to ensure transitional care for high-risk patients.

Implementation of Case Management in emergency departments: the influencing factors

Implementation of Case Management in emergency departments: the influencing factors

Application and effect evaluation of case management nursing practice mode in patients with precision radiotherapy for nasopharyngeal carcinoma

AbstractTo explore the application and effect evaluation of case management nursing practice mode in patients with nasopharyngeal carcinoma receiving precision radiotherapy. Fifty patients with nasopharyngeal carcinoma diagnosed for the initial treatment in our hospital from February 2020 to October 2020 were selected as the control group and 50 patients with the same condition in the same period were selected as the experimental group. The experimental group was trained by nurses to implement case management nursing practice mode for nasopharyngeal cancer patients; in the control group, nasopharyngeal cancer patients were treated with general nursing routine, such as health education and discharge guidance before chemotherapy and radiotherapy. Compared with the control group, self‐care ability and patient satisfaction of experimental group were improved to a certain extent, and the differences were statistically significant (p < .05). The nursing practice mode of case management is suitable for patients with cancer and chronic diseases. The mode can provide continuous and high‐quality nursing for patients, improve patients' self‐care ability, satisfaction with hospitalization, and so forth, and thus is worthy of clinical application.

Apoio matricial na atenção especializada respaldado no modelo de atenção às condições crônicas: pesquisa avaliativa

ABSTRACT Objective: To analyze the matrix support for health teams in Specialized Outpatient Care, according to the Chronic Conditions Care Model. Method: Qualitative evaluative research, conducted by the Chronic Conditions Care Model, carried out from February to July 2020. For data collection, interviews were carried out with 21 health professionals, assistance observation and document analysis of the service. Data were analyzed by data triangulation, with the aid of the MAXQDA software, respecting all ethical aspects. Results: The matrix support provided approximation between Primary and Secondary Care; implemented case management and qualified comprehensive care for people with chronic conditions. Weaknesses in communication and understanding of the theoretical bases of matrix support were obstacles to the proper implementation of matrix strategies. Final consideration: Matrix support for specialized health teams qualified the professional care given to people with chronic conditions treated at the service.

Implementation of Case Management in emergency departments: the view of the involved staff

Abstract Introduction Frequent users of emergency departments (FUED; ≥ 5 ED visits in the previous 12 months) often present with somatic, psychological and substance use problems. Providing a Case Management (CM) intervention may reduce their number ED visits and improve their quality of life. However, there is limited knowledge about the implementation process of CM. Methods This study aimed to introduce CM into the EDs in the French-speaking part of Switzerland and to identify the facilitators, barriers and needs encountered in this process. Semi-structured interviews were conducted with ED involved staff. An inductive content analysis was conducted. Results Among 13 invited hospitals, 8 implemented CM (62%); 23 ED staff were sampled from all participating ED: 17 nurses (74%), 5 physicians (22%) and 1 healthcare manager (4%). The average age was 48,48 years (SD = 8,64) and 74% were female. Four main facilitators emerged from the analysis: 1) Direct hierarchy support and flexibility (e.g. time management, supplemental paid hours); 2) Exchange with colleagues (e.g. debriefing, support); 3) Supervision by the research team (training and toolkit consisting of a binder and USB stick containing the study presentation and implementation procedures); and 4) Motivation (pleasure to work on an innovative project, benefit for patients and caregivers). Lack of resources was an unanimously mentioned barrier (e. g., time to identify and contact FUED medical and social support). Finally, participants identified the following needs to enable CM implementation: official and protected time for the project, a dedicated room for CM, at least two team members involved in the project since its initiation with complementary skills (e.g.: somatic, psychiatric and social). Conclusions Our study suggests that successful CM implementation is a complex process that, in addition to motivated ED staff, requires significant dedicated resources, such as protected time and a devoted support team. Key messages

Bilingual care navigation and enhanced case management during COVID-19.

COVID-19 disparities exposed health inequity across socioeconomic status, with community members of color experiencing higher rates of COVID-19 infections, hospitalizations, and death. Racial/ethnic differences were especially disparate in Benton and Washington counties in northwest Arkansas, a region in the United States that experienced high COVID-19 infection rates. To address these disparities and support families with COVID-19, the University of Arkansas for Medical Sciences and Community Clinic (a federally qualified health center) worked with the Arkansas Department of Health and community partners to develop systematic Care Navigation and Enhanced Case Management. During an initial screening process, contact tracers offered Care Navigation and Enhanced Case Management services to individuals who tested positive for COVID-19 within Washington and Benton counties. Bilingual community health navigators, social workers, and nurses began providing enhanced case management to households that accepted services. Between September 9, 2020 and June 19, 2021, 3,502 households representing ∼13,000 individuals were offered services, and 1,511 (43.1%) households requested/accepted services. Based on our experience, we provide four recommendations for practice: (a) provide contact tracing in community members' preferred language, (b) incorporate assessments into the contact tracing process to ensure community members have necessary resources for quarantine, (c) implement comprehensive care navigation and case management services for those who need additional support, and (d) integrate bilingual health navigators who are part of the target community into the process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Case Management in Ukrainian Civil Justice: First Steps Ahead

The article aimed to analyze case management in civil justice in Ukraine. Ukraine is one of the members of the Council of Europe and declares its integration path towards the European Union. The Association Agreement between the EU and Ukraine was signed in 2014 and requires the approximation of national legislation, which led to reforms, covering various areas of legal regulation. In the research, the comparative method was used to analyze the legislative provisions of case management, together with the structural method and the historical method to reveal the background of the idea of case management in the past research of Roman Law. The authors concluded that the deep historical beginnings of case management are based on Roman law, and the idea of restoring this phenomenon is fully reasonable today. Finally, the implementation of case management in procedural legislation must be reassessed and adapted to the complex of the rights protection system, helping to transform the role of the court in the dynamics of the civil judicial process.

The Power of Mentoring: Leveraging Evidence-Based Practice.

Teresa M. Treiger, RN, MA, CCM, FABQAURP, is Commissioner of the Commission for Case Manager Certification, and Principal of Ascent Care Management, Quincy, MA, specializing in private client case management, education, program design, and writing. Her health care career has spanned across the continuum. She designed and implemented case management, transition of care, frequent emergency department utilization, and uncompensated care programs. Her clinical experience includes acute and rehabilitation care. MaryBeth Kurland, CAE, is CEO of the Commission for Case Manager Certification, the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. The Commission is a nonprofit, volunteer organization that oversees the process of case manager certification with its CCM credential and the process of disability management specialist certification with its CDMS credential. Address correspondence to MaryBeth Kurland, CAE, Commission for Case Manager Certification, 1120 Route 73, Ste 200, Mount Laurel, NJ 08054 ([email protected]). The authors report no conflicts of interest.

Superpowers in Practice.

Teresa M. Treiger, RN, MA, CCM, FABQAURP, is the Past President of CMSA. She is Principal of Ascent Care Management, Quincy, MA, specializing in private client case management, education, program design, and writing. Her health care career has spanned across the continuum. She designed and implemented case management, transition of care, frequent emergency department utilization, and uncompensated care programs. Her clinical experience includes acute and rehabilitation care. Address correspondence to Teresa M. Treiger, RN, MA, CCM, FABQAURP, Ascent Care Management, Quincy, MA 02171 ([email protected]). The intent of this column is meant to speak to the heart of case management: our joys, our struggles, and our lessons learned. Please send your thoughts and ideas to us so we may include them in future articles. Teresa M. Treiger at: [email protected] The author reports no conflicts of interest.

Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

BackgroundAn upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life.MethodsA realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process.ResultsTwenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners.ConclusionsPrimary care practitioners’ use of tools to assess patients/families’ needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families’ outcomes.

Perceived barriers to implementing case management for medical-aid beneficiaries in South Korea.

Medical aid (MA) in South Korea, a national public assistance scheme, provides minimum medical security for low-income families. The Korean government has adopted a case management (CM) programme to control MA beneficiaries' inappropriate medical use and enhance beneficiaries' quality of life. This study aimed to explore case managers' experiences of implementing CM for MA beneficiaries' potential barriers. This study employed a qualitative phenomenological tradition using focus-group interviews. Three focus groups with 19 MA case managers were conducted (July to August 2018) using semistructured interview questions. Data were analysed through qualitative content analysis using the NVivo software programme, followed by consensus meetings between researchers. Participants perceived the structural barriers to CM implementation as a contradictory MA system, lack of communication among government departments and CM guidelines not reflecting reality. Five themes were derived as the personal barriers: burnout, the conflict between private values and CM goals, role confusion, beneficiaries' blame, and lack of acknowledgement from coworkers. To improve case managers' experiences concerning MA beneficiaries, policy solutions and a collaborative environment with beneficiaries, public nurses and social service providers are needed to ensure the workforce's sustainability. Also, it is required to develop practical guidelines that reflect the reality of implementing CM.

Delphi Approach to explore ways to optimize case manager services in inpatient wards of Sanglah General Hospital

Background and purpose: Case manager services in inpatient rooms have gained popularity in many hospitals in Indonesia, however there are challenges in its implementation. This study aims to explore ways to optimize the characteristics of the case manager, case management practice and outcome of the case manager in cases in inpatient wards based on the Sanglah Hospital standards.Methods: The study utilized a two-stage Delphi study design, started with a qualitative data collection and followed by a quantitative survey. Data collection was done in May-June 2020 based on the concept of case manager characteristics, practice and outcomes. The qualitative data collection through in-depth interviews involved 9 key informants. It aimed to explore case manager services based on qualifications, competencies, ethical standards, workload, hierarchy and guidelines, implementation of case management and indicators of effectiveness of case management at Sanglah General Hospital. The results of the in-depth interviews with thematic analysis informed the Delphi survey instrument development. The Delphi survey aimed to generate agreement on the characteristic of the case manager, case management practice and outcome of the case manager among 21 expert panelists (case managers) in the inpatient wards of Sanglah Hospital. This Delphi survey was conducted in 3 rounds, the results were analyzed based on the median value and quartile deviation (QD).Results: The three rounds of the Delphi survey showed that there was an agreement regarding the qualifications of the case manager, competency development, mechanism for appointment and placement of case managers, case manager guidelines, organizational structure, job descriptions and authorities, information of the presence and role of case managers, screening indicators according to characteristics of inpatient cases, case management target measurement tools, case manager service evaluation indicators as well as the activity feedback loop.Conclusion: Optimization of the case manager service should focus on aspects of human resources, developing guidelines and work systems as well as evaluation indicators and feedback mechanism.

Linking HIV-positive people in addiction care to HIV services in St. Petersburg, Russia – Mixed-methods implementation study of strengths-based case management

ABSTRACT Access to HIV services for HIV-positive patients in addiction care is challenging in Russia, because both care systems are organised independently from each other. Strengths-based case management is an effective strategy to connect people with HIV (PHIV) to HIV care. This mixed-methods study’s objective was to investigate implementation of a case management intervention in St. Petersburg, Russia, designed to connect PHIV who inject drugs to HIV care. We analysed survey data from 118 HIV-positive patients in addiction care and conducted six focus groups (n=38). Quantitative analyses of fidelity and satisfaction outcomes and qualitative text analysis assessed intervention implementation. Participants who linked to HIV services embraced empowerment and motivation resulting from case management as supporting self-efficacy and linkage to services. Among participants who did not link to care, drug use impeded their care engagement. Main levers to implementation were empowerment to cope with challenges of a fragmented health system and persistent stigma. Those who connected to HIV services credited case managers for facilitating linkage; those who did not link attributed it to personal issues. Implementation of case management for HIV care in Russia should focus on effective substance use treatment and empowerment, motivation and support in addressing personal and system factors.

Implementing Case Management with Positive Youth Development to Empower Young Mothers in California

ObjectivesWith funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs.MethodsThis implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods.ResultsAs designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar.Conclusions for PracticeIntegrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation.