Need For Case Management Research Articles

Parents' expectations regarding case management for rare diseases in Switzerland: mixed-method findings from an online survey.

This pilot study aims to enhance understanding by examining parents' specific views on the requirements, content and objectives of case management and advanced care coordination for children with rare diseases during childhood. The findings of this study are expected to offer valuable insights and recommendations for existing and future initiatives in clinical practice and research, with the goal of improving the comprehensive, child-centred and family-orientated approach to case management. This pilot study is part of an ongoing prospective study (SPACE), involving parents and families from various networks in Switzerland. Participants were parents recruited from the Children with Rare Diseases (KMSK) network consisting of families with children with rare diseases. The survey questionnaire covered demographic information; expectations and perceived need for case management; assessment of their quality of life and their child's suffering; and evaluation of interprofessional and interdisciplinary communication. Qualitative data from free-response answers were analysed using Mayring's content analysis and descriptive statistics were used to analyse quantitative data from Likert-scale questions. The study included 108 respondent families from among the 775 in the KMSK, a 14% response rate. The age of their children ranged from 0.4 to 24 years (mean: 8) and their level of suffering in the past six months varied, with 31.5% indicating intense or very intense suffering. In terms of case management, 15.8% of families reported access while 32.4% expressed a need but did not have access to it. The study identified three categories of parental expectations regarding case management, emphasising the importance of interprofessional collaboration, effective communication and comprehensive support. The findings shed light on the high need for case management support with a current undersupply in Switzerland and an association with reduced parental quality of life, highlighting the necessity for diverse support and assistance to effectively manage the challenges faced by families with children with rare diseases.

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.

Availability of Oxygen and Other Essential Medical Products in COVID-19 Treatment Facilities of Nepal

Background: There is paucity of data globally regarding availability of essential medical products and oxygen supply in healthcare facilities to inform surge capacity and strategic healthcare development. Due to continued waves of COVID-19 pandemic caused by virus variants with increased transmissibility, many facilities worldwide, particularly in the Indian subcontinent, have reported sudden increase in demand for oxygen and its delivery systems to treat patients with COVID pneumonia. Therefore, we aimed to assess the status of essential medical products, oxygen supply, and methods of procurement in COVID-19 treatment facilities across Nepal. Methods: We performed cross-sectional survey among 120 COVID-19 treatment facilities designated by the Government of Nepal in June 2020. Data were collected via an online semi-structured questionnaire based on validated healthcare capacity assessments. responded (49 clinics, 20 level hospitals). Findings: Sixty-nine facilities responded (49 clinics, 20 hospitals). All 69 facilities reported at least one form of oxygen availability: 25 facilities (36%) had their own oxygen plant, 65% had oxygen concentrators, and 88% had portable oxygen cylinders. Majority (38/49; 77%) of clinics and 60% (12/20) of hospitals had sufficient stock (³5 pieces in clinics, >20 pieces in hospitals) of functional oxygen cylinders, which were generally procured through the private sector (78% of facilities with oxygen cylinders). Almost all clinics had at least one piece of pulse oximeter device, blood pressure measuring set, thermometer, thermal gun, and resuscitation kit (oral or nasal airway, suction), compared to approximately a half of hospitals which had sufficient quantity (>10 pieces) of these products. Interpretation: It is crucial for hard-hit countries to timely map the availability and usage of essential medical products including oxygen in COVID-19 care hospitals. If needed, relevant policies and processes around oxygen production and supply should be revised. Furthermore, countries should not delay in adopting innovation for quicker, safer and sustainable production of medical oxygen to ensure continuous supply to the needy. Funding Information: No funding was received to conduct this study.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The study was approved by the Ethical Review Board (ERB) of Nepal Health Research Council ((Ref: NHRC-ERB Reg. No. 267/2020P), and utilizes specific data collected from a larger study done “to assess the service availability and infection prevention status of hospitals in Nepal in the context of possible COVID-19 case management need”.

The Impact of COVID-19 and the Critical Need for Case Management.

The Impact of COVID-19 and the Critical Need for Case Management.

PRISMA: Program of Research to Integrate the Services for the Maintenance of Autonomy. A system-level integration model in Quebec.

The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) began in Quebec in 1999. Evaluation results indicated that the PRISMA Project improved the system of care for the frail elderly at no additional cost. In 2001, the Quebec Ministry of Health and Social Services made implementing the six features of the PRISMA approach a province-wide goal in the programme now known as RSIPA (French acronym). Extensive Province-wide progress has been made since then, but ongoing challenges include reducing unmet need for case management and home care services, creating incentives for increased physician participation in care planning and improving the computerized client chart, among others. PRISMA is the only evaluated international model of a coordination approach to integration and one of the few, if not the only, integration model to have been adopted at the system level by policy-makers.

Analysis of new workers' compensation claims in the Department of Defense civilian workforce, 2000-2012.

This study of Department of Defense (DoD) civilian employees Workers' Compensation (WC) claims for chargeback year 2000 through 2012 aimed to analyze the frequency, rates, and costs of WC claims representing 5% of the DoD annual personnel budget. A multiyear cross-sectional study of WC claims data identified the top five most frequent causes, natures, and anatomical sites; changes in frequency, worker age, costs, and time were evaluated for trends. The annual frequency and rate of new DoD WC claims decreased over time, whereas costs per new claim have increased. New claim frequencies, rates, and costs aggregated in older age groups. The increasing trend in costs of each claim and the overall program costs presents a need for case management. Analysis of WC claims data is necessary to help target injury prevention efforts and reduce program costs.

An integrative review of nurse‐led community‐based case management effectiveness

Accountable, continuous and patient-centred care in community-based settings is increasingly needed to reduce fragmented care, especially to reduce patient readmission rates. Case management has been proven effective in reducing healthcare costs and in increasing continuity of care, but its effectiveness in community-based settings is not clear. The aim of this integrative review is to examine the effectiveness of community-based case management programmes in improving patient outcomes. An integrative review of articles from PubMed, CINAHL and PsycInfo databases was undertaken to synthesize and analyse research about community-based case management and its outcomes. Studies looking for patient outcomes and empirical studies published since 2000 were included. A total 18 articles were retrieved from 2000 to 2013. Most of the included studies were conducted in the USA, but international studies with quantitative approaches were reviewed (n = 6). The review revealed that community-based case management significantly reduced hospital access outcomes, especially readmissions and increased cost effectiveness, patient clinical outcomes and patient satisfaction. This study did not isolate studies of patients with diseases or demographic characteristics in common, resulting in large variations in disease and demographic factors. There is a base of evidence that community-based case management is effective. Because it provides quality, patient-centred care, case management should be used for major care coordination. The benefits of community-based case management need to be announced to healthcare leaders and policymakers.

Leadership Development and Succession Planning in Case Management

The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

Is there a difference? A comparative study of mobile intensive treatment team and continuing care team consumers’ clinical and other characteristics

Assertive community treatment has become widely accepted as a vehicle for providing treatment for mental health consumers who require intensive community follow up due to their numerous and lengthy presentations to hospital. This study was designed to identify the clinical differences in consumers who access case management through community mental health services and those who receive services through a mobile intensive treatment team (MITT). The findings indicate that consumers in MITT had higher dynamic risk factors, receive involuntary care through the Mental Health Act and had increased physical health care needs. In addition, MITT consumers were socially isolated and most were living alone with a history of unemployment. The findings identified that MITT clients were significantly more disabled on the indicators assessed and were likely to require the more intensive treatment provided through assertive follow-up. The smaller caseloads found in assertive models of case management need to be maintained to enable clinicians to deal with clients who have complex needs.

Is There a Difference? A Comparative Study of Mobile Intensive Treatment Team and Continuing Care Team Consumers Clinical and Other Characteristics

Assertive community treatment has become widely accepted as a vehicle for providing treatment for mental health consumers who require intensive community follow up due to their numerous and lengthy presentations to hospital. This study was designed to identify the clinical differences in consumers who access case management through community mental health services and those who receive services through a mobile intensive treatment team (MITT). The findings indicate that consumers in MITT had higher dynamic risk factors, receive involuntary care through the Mental Health Act and had increased physical health care needs. In addition, MITT consumers were socially isolated and most were living alone with a history of unemployment. The findings identified that MITT clients were significantly more disabled on the indicators assessed and were likely to require the more intensive treatment provided through assertive follow-up. The smaller caseloads found in assertive models of case management need to be maintained to enable clinicians to deal with clients who have complex needs.

Community mental health nurses, caseloads, and practices: A literature review

Deinstitutionalization, and more recently, earlier discharges from psychiatric inpatient units, have created and intensified the need for case management in community mental health. Nurses have been at the forefront of providing this case management. This literature review provides a synthesis of research and policy on the contribution of mental health nurses to community case management. The focus of this review is on the proportion of case management that mental health nurses undertake, the caseloads of case managers, and the interventions that mental health nurses most frequently perform in the community. The professional compositions of mental health case management workforces have been associated with economic imperatives, professional priorities, and the choice of case management models. The influence of mental health nurses in the case management workforce is particularly strong in the U.K. and Australia, but less so in the U.S.A. where social workers and people without mental health qualifications perform similar roles. Although heavy caseloads seem to be common among case managers, the research in this area is quite weak. The interventions that mental health nurses perform most often include case management (e.g., coordinating care), counselling, and medication management. Caring for the physical health of consumers might often be overlooked.

Rise in Chronic Conditions Indicates Greater Need for Case Management

Dorothy Consonery-Fairnot, MSHA, RN, CCM, CLNC, is Chair-elect of the Commission for Case Manager Certification (CCMC). The CCMC is the first and largest nationally accredited organization that certifies case managers. (For more information, see the Web site at www.ccmcertification.org). She is also President of Fairnot and Associates Healthcare Consulting, LLC, and has more than 16 years of experience in management of workers' compensation case management. Address correspondence to Dorothy Consonery-Fairnot, MSHA, RN, CCM, CLNC, Commission for Case Manager Certification, 15000 Commerce Parkway, Suite C, Mount Laurel, NJ 08054 ([email protected]).

Approving for a Community Aged Care Package: Experiences and perceptions of six metropolitan aged care assessment service teams

To establish whether the experiences and perceptions of different metropolitan Aged Care Assessment Service (ACAS) teams when approving people for Community Aged Care Packages (CACPs) were similar. Six semi-structured 30-minute group interviews were completed. ACAS team approval processes for CACPs were similar. The primary criterion for approval was need for case management. Many factors, however, impinged on the approval process. Barriers to making approvals included long waiting times, a lack of confidence in the priority rating system, and consideration of whether a person was better off with Home and Community Care services because of the impact of the Australian Government's Cost Recovery policy. ACAS teams have competing considerations when approving a person for a CACP. In particular, structural barriers, such as cost recovery policies, can have a significant negative impact on approval decisions.

Case Management Quality-of-Life Outcomes for Adults with a Disability

The increasing number of working-age adults with a long-term disability has created a need for case management focused on quality-of-life issues as well as functionality. An adaptation of the Quality Health Outcomes Model was used to explore relationships between case manager types and services and characteristics of adults with a disability. Outcome measures included social participation, health maintenance behaviors, and economic productivity. Secondary data analysis of the 1994 National Health Interview Survey Disability Supplement provided a purposive sample of 371 working-age adults with a disability (AWDs). Problems with instrumental activities of daily living and activities of daily living were reported by 74.7% of participants, with activity limitations a main predictor of outcome achievement. Although family members or friends were chosen by 78% of the sample to coordinate their medical care, case manager type demonstrated no influence on the outcome measures. Rehabilitation nurses should use their knowing of person to develop, implement, and evaluate interventions and systems focused on the ability of AWDs to achieve quality-of-life outcomes.

Case Management Decision Support Tools: Predictive Risk Report or Health Risk Assessment?

It is unclear whether health risk assessment (HRA) or claims-based risk modeling is a superior indicator of the need for case management in Medicaid adults with disabilities. This is a prospective cohort study designed to compare the use of a claims-based Predictive Risk Report (PRR) to a HRA in a Medicaid Supplemental Security Income managed care population. Both the claims-based risk scores and HRAs proved to be significant predictors of case management placement and subsequent emergency department and hospital utilization. The PRR-derived risk scores, however, could be obtained on virtually all enrollees at the time of enrollment, while HRA scores were obtained on only 54% of enrollees by 210 days of enrollment. Furthermore, case management reduced the risk of emergency and hospital utilization. We conclude that the PRR and HRA are equally reliable predictors of need for case management. The PRR has the advantage of earlier availability and of being easier to obtain.

Establishing a Nursing Presence within a Community-Based Domestic Violence Program

Community-based domestic violence centers provide an array of services, tailored to meet the multiple needs of victims and their families: counseling, safe shelter, legal aid, and social services. One community-based center observed another unmet need among its clients: the essential need for a client and his or her family to achieve and maintain optimal levels of health and well-being. Collaborating with other community providers, a committee was created and charged with developing a health program that would address the need for case management, health education, and advocacy. This article chronicles the work of this organization in developing provider partnerships and support for integration of a nursing presence in this nontraditional practice setting. A case scenario is provided to demonstrate the complexity of a domestic violence victim’s needs and to illustrate how an advance practice registered nurse or extensively experienced and skilled baccalaureate-prepared registered nurse is well suited for this role.

Patient-focused research: Using patient outcome data to enhance treatment effects.

A program of research aimed at improving the quality of psychological interventions is described. Data from over 10,000 patients were analyzed to understand the association between number of treatment sessions and clinically significant improvement. In addition to a potential dose-response relationship, typical recovery curves were generated for patients at varying levels of disturbance and were used to identify patients whose progress was less than expected ("signal" cases). The consequences of passing this information along to therapists were reported. Analyses of dose-response data showed that 50% of patients required 21 sessions of treatment before they met criteria for clinically significant improvement. Seventy-five percent of patients were predicted to improve only after receiving more than 40 treatment sessions in conjunction with other routine contacts, including medication in some cases. Identification of signal cases (potential treatment failures) shows promise as a decision support tool, although further research is needed to elucidate the nature of helpful feedback. Outgrowths of this research include its possible contribution to social policy decisions, reductions in the need for case management, use in supervision, and possible effects on theories of change.

GERIATRICS IN MANAGED CARE

To measure the effects of case management on an older population's costs of health care. A 1-year randomized controlled trial. Multiple sites of care in San Francisco, California. Patients aged 65 or older of primary care physicians in a large provider organization bearing financial risk for their care (n = 6409). Screening for high risk and provision of social work-based case management. Volume and cost of hospital, physician, case management, and other health-related services. The experimental group used more case management services than the control group (0.09 vs. 0.02 months per person, P<.001). The experimental group's average total payments for health care were slightly lower ($3148 vs $3277, P = .40). This study provides no statistically significant evidence that social work-oriented case management reduces the use or the cost of health care for high-risk older people. Other potentially favorable effects of this type of case management need to be evaluated, as do the effects of other types of case management.

Clients' Functioning and Need for Case Management

This paper describes the transition and reorganization of a Community Support Service, previously functioning as a traditional management program with high caseloads. Through the development and use of a tier system, based on functioning, clients were provided service commensurate with need.

Impact of a mass vaccination campaign against a meningitis epidemic in a refugee camp.

Serogroup A meningococcus epidemics occurred in refugee populations in Zaire in August 1994. The paper analyses the public health impact of a mass vaccination campaign implemented in a large refugee camp. We compared meningitis incidence rates from 2 similar camps. In Kibumba camp, vaccination was implemented early in the course of the epidemic whilst in the control camp (Katale), vaccination was delayed. At a threshold of 15 cases per 100 000 population per week an immunization campaign was implemented. Attack rates were 94 and 134 per 100,000 in Kibumba and Katale respectively over 2 months. In Kibumba, one week after crossing the threshold, 121,588 doses of vaccine were administered covering 76% of all refugees. Vaccination may have prevented 68 cases (30% of the expected cases). Despite its rapid institution and the high coverage achieved, the vaccination campaign had a limited impact on morbidity due to meningitis. In the early phase in refugee camps, the relative priorities of meningitis vaccination and case management need to be better defined.