Case Management Model Research Articles

Older Spousal Dyads and the Experience of Recovery in the Year After Traumatic Brain Injury.

BACKGROUND: Significant others of older persons with traumatic brain injury (TBI) may be more likely to face increased caregiving responsibilities, leading to increased relationship challenges. Relatively little is known about this cohort. The study aimed to describe the impact of experiencing a mild/moderate TBI on the older adult as well as the significant other in the year post injury. DESIGN AND METHODS: This is a multiple-case study using data from a larger parent study. Qualitative content analysis of interviews conducted at 1, 3, 6, and 12 months post injury with 3 dyads was performed (24 interviews) and included cross-case and cross-time comparisons. RESULTS: Dyads that included persons 65 years and older with a mild-moderate TBI and their significant others were enrolled (N = 3/6 individuals). The identified themes were struggling to accept limitations and acceptance, gratitude, fear and concern, frustration/anger/guilt/resentment, broader social support, emotional coping, and the presence or absence of broader social support. CONCLUSIONS: Feelings of hope, gratitude, and acceptance serve as vital ways for couples to continue toward a path of recovery and healing. Lack of social support was a stressor, creating a barrier to recovery. Significant others tended to focus on others versus self-care needs. Nurses should integrate social support and self-care into the assessment of the spousal dyad after TBI. These findings can also inform the development of support groups and case management models for both patients after TBI and their significant others.

A case management occupational health model to facilitate earlier return to work of NHS staff with common mental health disorders: a feasibility study.

The NHS is the biggest employer in the UK. Depression and anxiety are common reasons for sickness absence among staff. Evidence suggests that an intervention based on a case management model using a biopsychosocial approach could be cost-effective and lead to earlier return to work for staff with common mental health disorders. The objective was to assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of an early occupational health referral and case management intervention to facilitate the return to work of NHS staff on sick leave with any common mental health disorder (e.g. depression or anxiety). A multicentre mixed-methods feasibility study with embedded process evaluation and economic analyses. The study comprised an updated systematic review, survey of care as usual, and development of an intervention in consultation with key stakeholders. Although this was not a randomised controlled trial, the study design comprised two arms where participants received either the intervention or care as usual. Participants were NHS staff on sick leave for 7 or more consecutive days but less than 90 consecutive days, with a common mental health disorder. The intervention involved early referral to occupational health combined with standardised work-focused case management. Participants in the control arm received care as usual. The primary outcome was the feasibility and acceptability of the intervention, study processes (including methods of recruiting participants) and data collection tools to measure return to work, episodes of sickness absence, workability (a worker's functional ability to perform their job), occupational functioning, symptomatology and cost-effectiveness proposed for use in a main trial. Forty articles and two guidelines were included in an updated systematic review. A total of 49 of the 126 (39%) occupational health providers who were approached participated in a national survey of care as usual. Selected multidisciplinary stakeholders contributed to the development of the work-focused case management intervention (including a training workshop). Six NHS trusts (occupational health departments) agreed to take part in the study, although one trust withdrew prior to participant recruitment, citing staff shortages. At mixed intervention sites, participants were sequentially allocated to each arm, where possible. Approximately 1938 (3.9%) NHS staff from the participating sites were on sick leave with a common mental health disorder during the study period. Forty-two sick-listed NHS staff were screened for eligibility on receipt of occupational health management referrals. Twenty-four (57%) participants were consented: 11 (46%) received the case management intervention and 13 (54%) received care as usual. Follow-up data were collected from 11 out of 24 (46%) participants at 3 months and 10 out of 24 (42%) participants at 6 months. The case management intervention and case manager training were found to be acceptable and inexpensive to deliver. Possible contamination issues are likely in a future trial if participants are individually randomised at mixed intervention sites. No adverse events were reported. The method of identification and recruitment of eligible sick-listed staff was ineffective in practice because uptake of referral to occupational health was low, but a new targeted method has been devised. All study questions were addressed. Difficulties raising organisational awareness of the study coupled with a lack of change in occupational health referral practices by line managers affected the identification and recruitment of participants. Strategies to overcome these barriers in a main trial were identified. The case management intervention was fit for purpose and acceptable to deliver in the NHS. Current Controlled Trials ISRCTN14621901. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 12. See the NIHR Journals Library website for further project information.

An Innovative Case Management and Immigrant Onboarding Model Developed by the Sharewood Project in Massachu.

The Sharewood Project, a student-run free project developed by Tufts University School of Medicine students in 1997, provides limited medical care and social services to a diverse population in Malden, Massachusetts. The project plays an unusual role in introducing immigrants to the health care and education systems in Massachusetts.

A plan to establish a cooperation model for case management for people with disabilities in local communities and the changing role of welfare centers

A plan to establish a cooperation model for case management for people with disabilities in local communities and the changing role of welfare centers

Mothers experiences of the Parenting Under Pressure Program (PuP) in a Residential Therapeutic Community: A qualitative study

ABSTRACT Several studies suggest parental substance use, while not always the case, exposes children to a higher risk of physical, psychological, behavioral and emotional problems. Identifying interventions that best support the parent and child needs is imperative. The PuP programme aims to improve family functioning and child outcomes by supporting parents who are or have been drug or alcohol dependent. PuP combines psychological principles relating to parenting, child behavior and parental emotion regulation within a case-management model. The current study was the first evaluation of the PuP program in a residential setting globally. Twenty-three women took part in pre and post-program qualitative interviews. Guilt was a dominant theme across interviews. The principal expectation of participants was to improve their relationships and access to their children. The benefits of the PuP program to the women and their children, as reported by participants, were immediate and direct. As the women progressed through the program, they were visibly building belief in their abilities to parent.

Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients.

Explore the perceptions of primary care physicians (PCPs) from community health care centers (CHCs) in Franklin County, Ohio, regarding factors that contribute to their inability to consistently provide sustainable asthma management services to their uninsured patient population. Asthmatic patients are not consistently receiving sustainable asthma management in CHCs in Ohio. Primary care physicians in CHCs play a pivotal role in closing health care gaps for asthmatic patients. To minimize the barriers that impede the efforts of PCPs to control asthma for their uninsured patients, asthma disease management programs that include case management services in CHCs in Franklin County, Ohio, are needed. A convenience sample of 4 PCPs from 2 CHCs in Franklin County, Ohio, was interviewed face-to-face. Interviews, direct observation, and previously published research were the sources of data utilized for this study. Results indicated that 75% of participants did not use standard guidelines while treating their patients. Physician time constraints and access to affordable medication were identified as some of the barriers to providing sustainable asthma management services. Asthma is a complex chronic disease. Disease case managers not only are capable of coordinating health care services for a variety of patient populations but are also effective in managing complex diseases such as asthma for disadvantaged populations. Evidence-based case management models are needed to support PCPs in CHCs. Without the inclusion of asthma-specific case managers as part of the care delivery structure, CHCs may continue to provide subpar disease management services for uninsured asthmatic patients.

Disconnect between psychiatric and addiction services: a review of patients' attendances at Alcohol Tobacco and Other Drug Services after a psychiatric admission.

To investigate the rate of attendance at Alcohol Tobacco and Other Drug Services (ATODS) for patients discharged from an acute mental health unit with a primary/secondary diagnosis of substance use disorder (SUD); and describe factors, demographics, diagnoses and service provision that relate to their attendance. All inpatients between 1 November 2016 and 31 October 2017 with a diagnosis of SUD were compared for their attendance at ATODS within 30 days of discharge. Other measures included their admission data (e.g. demographics, diagnosis), and indices of their illness severity. Of 1295 admissions for a total of 900 patients, 32.4% of patients had an SUD diagnosis. Only 10.3% of these patients attended ATODS. There were no significant differences by gender, age, indigenous status, illness severity or dual diagnosis intervention during their inpatient stay on attendance. Relative to the SUD-only group, individuals with any psychiatric comorbidity were three-four times less likely to attend ATODS. Despite the ongoing emphasis on dual diagnosis treatment, the rate of engagement with ATODS remains low. Further review is needed to determine whether enhanced information sharing or case management models may improve attendance rates.

Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study

BackgroundChronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants’ health and wellbeing at 12 months.MethodsHOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months thereafter. Variables included self-rated health status, depression, utilisation of health services, and key clinical outcomes. Participants’ baseline characteristics were described using frequencies and percentages. Generalized estimating equation (GEE) models were employed to evaluate participant attrition and changes in outcome measures over time.Results60 participants were enrolled into the study and 37 (62%) completed the 12-month assessment. After receiving outreach case management for 12 months, 73% of participants had good, very good or excellent self-rated health status compared with 33% at baseline (p < 0.001) and 19% of participants had depression compared with 44% at baseline (p = 0.03). Significant increases in appointments with allied health professionals (p < 0.001) and medical specialists other than general practitioners (p = 0.001) were observed at 12-months compared with baseline rates. Mean systolic blood pressure decreased over time (p = 0.02), but there were no significant changes in mean HbA1c, body mass index, or diastolic blood pressure.ConclusionsThe HOME Study model of care was predicated on a holistic conception of health and aimed to address participants’ health and social care needs. The positive changes in self-rated health and rates of depression evinced that this aim was met, and that participants received the necessary care to support and improve their health and wellbeing.

Search strategies at the European Patent Office

Prior-art search is a critical step towards determining whether a patent can be granted or not. In 2016, an internal project called Search Workflow Modelling (SWM) was launched at the European Patent Office (EPO) for building a search knowledgebase, which contains a set of models that record not only the current situation on how patent examiners deal with prior-art search (i.e. the as-is models), but also their requirements of being able to do a more efficient and effective search (i.e. the to-be models). We use the Fact-based Modelling (FBM) approach for formalizing search ontologies, which cover a common vocabulary, relations between concepts related to search, and constraints applicable to these relations. We use a hybrid modelling approach of Business Process Modelling Notations and Case Management Model and Notations (BPMN/CMMN) to model search work flows. A patent search strategy typically involves at least one FBM model and at least one BPMN/CMMN model. In this paper, we will illustrate 5 types of existing search strategies (including recursive flow patterns and FBM models for future search features), and future search strategies. The SWM empirical studies in this paper are being put into practice in the ongoing projects concerning search tools at the EPO.

Onsite Mentorship Model for Isolation and Management of Viral Hemorrhagic Fever Syndromes at a Ugandan Hospital

Background:Uganda is prone to viral hemorrhagic fever (VHF) outbreaks. Infection prevention and control capacity is critical to supporting patient care, to preventing nosocomial transmission to health workers, and to limiting spread within the community. Offsite didactic training may increase healthcare worker knowledge, but this approach may be inadequate for assuring confident execution of practical clinical tasks in patient care settings. We aimed to develop a competency-based, onsite mentorship model for sentinel case isolation and management of viral hemorrhagic fever syndromes in Uganda. Methods: The Naguru Regional Referral Hospital (China Uganda Friendship Hospital) Kampala was selected as a site for training after its designation by the Uganda Ministry of Health (MoH) as facility for isolation of healthcare workers with suspected or confirmed VHF. The need for mentorships was determined from information from training providers, MoH assessments, hospital management, and key hospital staff. A list of skills was developed by reviewing WHO case management guidelines and Uganda-approved VHF trainings. The skills, exercised using scenario-based drills, focused on safety practices, identification and isolation of suspect cases, and delivery of optimized clinical care to suspected cases of VHF, among others. Trained facilitators (n = 2–4) supervised drills attended by staff from Naguru and other Kampala-based health facilities. Drills were scheduled weekly and were ordered to progressively increase in complexity. Specific drills could be repeated at the subsequent mentorship visit if gaps were identified. Results: Over 3 months, 12 drills were completed (Table 1). Cadres trained included 10 medical doctors, 12 nurses, 3 clinical officers, 5 laboratory technicians, 6 hygienists, 2 security officers, and 3 administrative officers. On average, 8 hospital staff attended weekly drills. During 3 months of the intervention, 1 suspected case of VHF and 3 cases with laboratory confirmed cholera were managed by the hospital team, and staff demonstrated the capacity for safe handling of patients with infectious bodily fluids. Barriers encountered included practice fatigue from repeated drills, challenges with team cohesion since members were from different institutions, limited personal protective equipment for repeated trainings, and competing routine hospital activities that reduced numbers of staff available for training. Repeated drills included clinical management, cadaver management, and infectious spills. Conclusions: This onsite mentorship project supported healthcare workers to gain confidence in the management of suspected VHF infection and other highly infectious diseases. Continued mentorship, hospital administration support and increase in exercise complexity are needed to consolidate on these gains.Funding: NoneDisclosures: Mohammed Lamorde reports contract research for Janssen Pharmaceutica, ViiV, and Mylan.

Case Management Models and Continuing Care: A Literature Review across nations, settings, approaches, and assessments

Older adults accessing continuing care often have multiple chronic conditions. Research suggests that case management is a promising approach to reduce health care expenditure and improve patient outcomes. To optimize healthcare delivery, an examination of existing case management models and their effectiveness is essential. This literature review was conducted using Joanna Briggs Institute (JBI) methods to explore case management models for older adults accessing continuing care services. Searches were conducted in PubMed and CINAHL from 2010 to 2018. A total of 37 articles were included in this review. Approaches to case management are diverse with respect to composition of care providers, method of care provision, and location of care. Findings from 27 quantitative studies demonstrated that nurse-led and interdisciplinary team case management models that include home visits can effectively reduce hospital admission/readmission while lowering costs. Mixed results were found on the impact of case management on patient satisfaction, ED visits, quality of life, length of stay, self-efficacy, social integration and caregiver burden. Among 10 qualitative studies, 3 facilitators for quality case management were identified that include receiving care at home, building trusting relationships, and improving self-efficacy. Based on these findings, we conclude that nurse-led and interdisciplinary team case management can effectively reduce hospital admission of frail older adults while lowering costs, particularly within home care settings.

Feature-oriented engineering of declarative artifact-centric process models

Declarative artifact-centric process models are suitable for specifying knowledge-intensive processes. Currently, such models need to be designed from scratch, even though existing model fragments could be reused to gain efficiency in designing and maintaining declarative artifact-centric process models. To address this problem, this paper proposes an approach for composing model fragments, abstracted into features, into fully specified declarative artifact-centric process models. We use Guard-Stage-Milestone (GSM) schemas as modeling language and let each feature denote a GSM schema fragment. The approach supports feature composition at different levels of granularity. Permutability of features is analyzed. Syntactic conditions that ensure permutability are defined and refactoring of non-permutable into permutable features is discussed. The approach has been evaluated by implementing it in a tool based on the Case Management Model Notation (CMMN) and applying it to three real-world processes. Using the approach, declarative artifact-centric process models can be composed from existing model fragments in an efficient, robust and correct way.

Keeping youth in the community through an intensive case management and family partnerships model

ABSTRACT The Family Partnerships Program (FPP) is an intensive case management model that serves families with child welfare and juvenile justice involved youth who are at imminent risk of out-of-home placement. FPP is based on the belief that relationships, both with families and across systems, is foundational when supporting change with youth. Propensity score matching was utilized to determine if FPP is related to improved child welfare re-involvement outcomes when compared with treatment as usual for this population. When compared to non-FPP youth in two comparison counties, FPP youth from Larimer County, Colorado experienced 51% lower odds of juvenile justice involvement at case closure compared to remaining home, 32% lower odds of runaway/emancipation compared to remaining home, and 74% lower odds of placement compared to remaining home. When comparing a group of youth from Larimer County who did not receive FPP to youth in the comparison counties, the results are similar. Although this effect does not appear to be isolated to FPP; one possibility is that intensive case management represents an “active ingredient” of what makes Larimer County’s community-based approach viable for serving the crossover youth population. Implications for program and policy development and directions for future research are discussed.

Effect of a multi-dimensional case management model on anti-retroviral therapy-related outcomes among people living with human immunodeficiency virus in Beijing, China

BackgroundThis paper introduces a comprehensive case management model uniting doctors, nurses, and non-governmental organizations (NGOs) in order to shorten the time from HIV diagnosis to initiation of antiviral therapy, improve patients’ adherence, and ameliorate antiretroviral treatment (ART)-related outcomes.MethodsAll newly diagnosed human immunodeficiency virus (HIV) cases at Beijing YouAn Hospital from January 2012 to December 2013 were selected as the control group, while all newly diagnosed HIV-infected patients from January 2015 to December 2016 were selected as the intervention group, receiving the comprehensive case management model.Results4906 patients were enrolled, of which 1549 were in the control group and 3357 in the intervention group. The median time from confirming HIV infection to ART initiation in the intervention group was 35 (18–133) days, much shorter than the control group (56 (26–253) days, P < 0.001). Participants in the intervention group had better ART adherence compared to those in the control group (intervention: 95.3%; control: 89.2%; p < 0.001). During the 2 years’ follow-up, those receiving case management were at decreased odds of experiencing virological failure (OR: 0.27, 95%CI: 0.17–0.42, P < 0.001). Observed mortality was 0.4 deaths per 100 patient-years of follow-up for patients in the control group compared with 0.2 deaths per 100 patient-years of follow-up in the intervention group.ConclusionsPeople living with HIV engaged in the comprehensive case management model were more likely to initiate ART sooner and maintained better treatment compliance and improved clinical outcomes compared to those who received routine care. A comprehensive case management program could be implemented in hospitals across China in order to reduce the HIV disease burden in the country.

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing, China: A case study.

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.

Establishing a Correctional Case Management Model for Jails Training Program (DOJ)

Federal Grants & ContractsVolume 44, Issue 15 p. 5-5 Grant Alerts Establishing a Correctional Case Management Model for Jails Training Program (DOJ) First published: 27 June 2020 https://doi.org/10.1002/fgc.31169Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume44, Issue152 July 2020Pages 5-5 RelatedInformation

Empirical evaluation of CMMN models: a collaborative process case study

Case Management Model and Notation (CMMN) was introduced by the Object Management Group as an alternative modeling language, targeting human-centric processes characterized by lack of structure and agility. However, although it is adequately supported by well-known process management tools, CMMN applicability as a modeling language is being questioned in practice. In this work, an empirical evaluation of CMMN models is presented, through a real-world case study where CMMN has been used for the analysis and implementation of a collaborative process by independent groups of process engineers. Their experience is being discussed, based on their modeling perspective. The produced models in the analysis and implementation phase are evaluated, using pre-existing metrics customized for CMMN. Based on the experience of engineers, CMMN applicability is evaluated, highlighting aspects in which its application might be limited, that should be addressed.

4340 Piloting Implementation and Dissemination of Best Practice Guidelines Using BPM+Health

OBJECTIVES/GOALS: Clinical translational studies inform clinical practice patterns through dissemination of clinical practice guidelines (CPG). In EM practices change to rapidly for timely local EHR implementation. We test the OMG BPM+Health specification for rapid deployment of best practices relevant to EM. METHODS/STUDY POPULATION: The OMG Business Process Management for Healthcare (BPM+Health) specification combines BPMN™ with Case Management Model and Notation (CMMN™) and Decision Model and Notations (DMN™) to “disseminate and leverage evidence-based best-practices at the point of care.” The American College of Emergency Physicians (ACEP) Board-certified Emergency Physicians modeled practice guidelines in the BPM+ modeling language during on-line meetings. Two common emergency conditions were selected for initial pilot testing: 1) evaluation and treatment of first trimester bleeding in pregnant patients, and 2) the evaluation and treatment of non-traumatic low back pain. RESULTS/ANTICIPATED RESULTS: The protocols were successfully modeled during four on-line meetings in less than 2 months. Process steps from initial evaluation to disposition were implemented using BPMN™. When clinicians need to evaluate the patient to collect data for decision making the inputs and outputs were modeled in CMMN™. Decision logic is represented as DMN™. The software tool linked the components for easy browsing and authoring the logic. The Physicians easily followed the displayed logic. The practice recommendations from each policy were successfully modeled, using the standard BPM+ notation to support rapid implementation in EHRs. Detailed implementation specifications will be shared. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot project demonstrated the feasibility of the OMG approach to solving Clinical Practice Guideline Implementation and Dissemination Barriers. Ongoing work by involved specialty societies will be necessary to demonstrate the scalability and sustainability of this approach.

Transitional Care Models for High-Need, High-Cost Adults in the United States: A Scoping Review and Gap Analysis.

This scoping review explored research literature on the integration and coordination of services for high-need, high-cost (HNHC) patients in an attempt to answer the following questions: What models of transitional care are utilized to manage HNHC patients in the United States? and How effective are they in reducing low-value utilization and in improving continuity? U.S. urban, suburban, and rural health care sites within primary care, veterans' services, behavioral health, and palliative care. Utilizing the Joanna Briggs Institute and PRISMA guidelines for scoping reviews, a stepwise method was applied to search multiple databases for peer-reviewed published research on transitional care models serving HNHC adult patients in the United States from 2008 to 2018. All eligible studies were included regardless of quality rating. Exclusions were foreign models, studies published prior to 2008, review articles, care reports, and studies with participants younger than 18 years. The search returned 1,088 studies, of which 19 were included. Four studies were randomized controlled trials and other designs included case reports and observational, quasi-experimental, cohort, and descriptive studies. Studies focused on Medicaid, Medicare, dual-eligible patients, veterans, and the uninsured or underinsured. High-need, high-cost patients were identified on the basis of prior utilization patterns of inpatient and emergency department visits, high cost, multiple chronic medical diagnoses, or a combination of these factors. Tools used to identify these patients included the hierarchical condition category predictive model, the Elder Risk Assessment, and the 4-year prognostic index score. The majority of studies combined characteristics of multiple case management models with varying levels of impact. .

Systemic Work of Carers of Community Dwelling Older People with Complex Care Needs: A Qualitative Study of Carers' Experiences

Informal carers provide the majority of direct care to older Australians and play an essential role in assisting older people with complex care needs to remain living in their own homes. With greater emphasis on the community as a more appropriate site for responding to and managing the needs of older people, carers are increasingly faced with systemic responsibilities, including coordination of fragmented services and providers across multifaceted health and aged care systems and negotiation of treatment and supports. Consequently, this work may be perceived by carers as burdensome. The aim of this qualitative study was to explore the lived experiences of carers of community-dwelling older adults in undertaking the systemic work of caring. Specifically, the aim was to explore their experiences of managing and coordinating treatment and supports across multiple services and systems. The concept of Burden of Treatment was used to understand the work of navigating, negotiating and managing care of the older person, how carers made sense of this, and what personal resources they drew on. A descriptive phenomenological approach was taken to guide the research. Semi-structured interviews were conducted with 16 carers of community-dwelling older adults with complex care needs. Giorgi’s phenomenological data analysis methods (1997) was utilised for the data analysis. Two main themes were derived from the analysis, each comprising three sub-themes. The first theme, Becoming part of the caring system, comprised: (a) Entering the caring system, (b) A sense of obligation and duty, and (c) Work at the nexus of present and future. The second major theme, Mastering the caring system, comprised: (a) Making connections, (b) Activating the management plan, and (c) Voicing and advocating needs in the caring system. Participants felt a sense of expectation and responsibility from others, including family and health and aged care providers to take on the caring work. Many perceived they had no alternative but to respond to systemic demands when seeking to manage the needs of the older person and described the challenge of this work as managing multiple and complex organisational and administrative processes across different systems while locating, accessing and coordinating services for the older person. The findings showed an experience of being adrift and having to piece together disjointed pathways. Participants also described the work of trying to make systems more responsive to the older person for a better outcome. Furthermore, the findings illustrated the varied skills required to master the systemic work, including administrative, communication, advocacy, problem-solving and negotiation abilities. Some carers drew on personal resources, robustness and abilities while others often felt overwhelmed and unsure of how to proceed. The findings indicate that through addressing the systemic work placed on carers, the burden placed on them can be alleviated. From a system perspective, streamlining and reducing duplication of assessments, improving information access, improving communication and targeting partnerships between differing organisations can reduce system complexity which in turn will reduce the demands made on carers. Consideration of models of system navigation, care co-ordination, and case management would support those who struggle to independently master the system. The findings also suggest that there is scope for health care professionals and service providers to better identify carer requirements and assess carer capacity to manage the work. Without investment to assist carers to do the increasingly complex work, there is a risk of disparity between those that are equipped to access services and supports and those that will that continue to flounder and forego appropriate care for the older person and support for themselves.