Provision Of Case Management Services Research Articles

Case management aftercare service provision to homeless people who use drugs in Iran; a nine-month post-treatment follow-up

ABSTRACT The aim of study was to assessing the provision of case management services to homeless people who use drugs. 4358 people were recruited and followed up for nine months after discharge. The average age of the participants were 37.8 ± 5.71. In the first month, 15.9% of the total participants had a job, about half abstained from illegal drug use, about 38% reunited with their families, 51.1% accommodated and 39.1% had identity documents. In the ninth month (N = 136), the variables of abstinence from illegal substances, family reunification and accommodation had the highest rates compared to previous months.

Gender-Based Violence Case Management Service

Gender-based violence (GBV) against women and girls is one of the most prevalent human rights violations being practiced across different countries, including Ethiopia. The main objective of the study is to assess the GBV case management service and associated factors on female survivors at the Association for Women Sanctuary and Development, Ethiopia. The mixed research approach that includes both quantitative and qualitative was employed with an institutional-based cross-sectional survey design. A total of 110 survivors were included in the study from two safehouses. A structured questionnaire was used as a survey instrument and interview guide employed for qualitative data collection. The factors associated with GBV were identified for analysis and categorized into individual, relationship, community, and societal level factors. A binary logistic regression and thematic analysis were used for quantitative and qualitative data, respectively. Findings indicate that survivors were brought to a safehouse due to sexual, physical, and psychological or verbal abuse. Most of the violence was committed by an intimate partner, relatives, and strangers. About 35.5% of survivors were not getting appropriate gender-based case management services. There is a need for urgent attention of those stakeholders who are engaged in the provision of case management services to improve their services regarding the four principles of GBV case management services, namely right to safety, confidentiality, respect, and dignity, plus the right to the best possible assistance without discrimination.

A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals.

Case management is a representation of managed care, cost-containment organizational practices in healthcare, where managed care and its constitutive parts are situated against physician autonomy and decision-making. As a professional field, case management has evolved considerably, with the role recently taken up increasingly by Advanced Practice Nurses in various health care settings. We look at this evolution of a relatively new work task for Advanced Practice Nurses using a countervailing powers perspective, which allows us to move beyond discussions of case management effectiveness and best practices, and draw connections to trends in the social organization of healthcare, especially hospitals. We evaluated organizational (hospital-level) and environmental (county and state-level) characteristics associated with hospitals' use of Advanced Practice Nurses as case managers, using data from U.S. community acute care hospitals for 2016-2018, collected from three data sources: American Hospital Association annual survey (AHA), Centers for Medicare and Medicaid Services (CMS), and Area Resource File. Among organizational characteristics, we found that hospitals that are a part of established Accountable Care Organizations (OR = 2.55, p = 0.009; 95% CI = 1.26-5.14) and those that serve higher acuity patients, as indicated by possessing a higher Case Mix Index (OR = 1.32, p = 0.001; 95% CI = 1.13-1.55), were more likely to use Advanced Practice Nurses as case managers. Among environmental characteristics, having higher local Advanced Practice Nurses concentrations (OR = 1.24, p < 0.001; 95% CI = 1.11-1.39) was associated with hospital Advanced Practice Nurses case management service provision. Beyond the health impacts of Covid-19, its associated recession is placing families, governments and insurers under unprecedented financial stress. Governments and insurers alike are looking to reduce costs anywhere possible. This will inevitably result in increasing amounts of managed care, and decreasing reimbursements to hospitals, likely resulting in higher demand for APRN patient navigators.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

ObjectiveTo describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalisation. MethodFollow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. ResultsData from 835 patients with a mean age of 76.8years (SD: 12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD: 2.5) and high dependence (Barthel 37.5, SD: 31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR: 1.41; 95% CI: 1.22–1.63), more telephone interventions by case managers (OR: 1.12; 95% CI: 1.02–1.24) and imaging tests (OR: 1.37; 95% CI: 1.17–1.60), together with greater caregiver burden (OR: 1.31; 95% CI: 1.08–1.59), the presence of medical devices at home (OR: 1.69; 95% CI: 1.00–2.87) and received less “Case Management” intervention. ConclusionsThe patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry.

To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Time, terrain and trust: Impacts of rurality on case management in rural Australia

There is a ‘black hole’ in our understanding of case management practice with earlier studies identifying this as a particular concern for rural contexts. Using grounded theory methodology, focus groups were conducted with Australian rural case managers to understand how the rural context impacts on the provision of case management services. Findings identified behaviours associated with lengthy rural travel, stemming from a demand for constant output; lack of familiarity with the rural landscape combined with the loss of mobile communication, led to early feelings of trepidation for some women accessing rural spaces; lastly, building inter-agency relationships are critical to successful collaborative work, yet are threatened by lack of trust and frequent turnover of rural programs. Further exploration of these themes, in the international context, would be of benefit.

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.

Suicide, an Urgent Health Issue in Korea

Suicide, an Urgent Health Issue in Korea

EHRs connect research and practice: Where predictive modeling, artificial intelligence, and clinical decision support intersect

ObjectivesElectronic health records (EHRs) are only a first step in capturing and utilizing health-related data—the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients’ health conditions and responses to treatment over time. MethodsWe describe a case study of 423 patients treated by Centerstone within Tennessee and Indiana in which we utilized electronic health record data to generate predictive algorithms of individual patient treatment response. Multiple models were constructed using predictor variables derived from clinical, financial and geographic data. ResultsFor the 423 patients, 101 deteriorated, 223 improved and in 99 there was no change in clinical condition. Based on modeling of various clinical indicators at baseline, the highest accuracy in predicting individual patient response ranged from 70% to 72% within the models tested. In terms of individual predictors, the Centerstone Assessment of Recovery Level—Adult (CARLA) baseline score was most significant in predicting outcome over time (odds ratio 4.1+2.27). Other variables with consistently significant impact on outcome included payer, diagnostic category, location and provision of case management services. ConclusionsThis approach represents a promising avenue toward reducing the current gap between research and practice across healthcare, developing data-driven clinical decision support based on real-world populations, and serving as a component of embedded clinical artificial intelligences that “learn” over time.

The Treatment Relationship in Peer-Based and Regular Case Management for Clients With Severe Mental Illness

This study compared the quality of treatment relationships and engagement in peer-based and regular case management. It also assessed the value of positive relationship qualities in predicting motivation for and use of community-based services for persons with severe mental illness. One hundred thirty-seven adults with severe mental illness participated in a 2x2 prospective longitudinal randomized clinical trial with two levels of case management intervention (peer and regular) and two interviews (six and 12 months). Self-report questionnaires assessed treatment relationships, motivation, and service use, and providers rated participants' initial engagement and monthly attendance in treatment. Participants perceived higher positive regard, understanding, and acceptance from peer providers rather than from regular providers at six months only, with initially unengaged clients showing more contacts with case managers in the peer condition and decreasing contacts in the regular condition. Six-month positive regard and understanding positively predicted 12-month treatment motivation for psychiatric, alcohol, and drug use problems and attendance at Alcoholics and Narcotics Anonymous meetings. Early in treatment, peer providers may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients and a facility for increasing treatment participation among the most disengaged, leading to greater motivation for further treatment and use of peer-based community services. Findings strongly suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system.

Development and implementation of an HIV/AIDS case management outcomes assessment programme

The Case Management Section of the New York State Department of Health AIDS Institute coordinates the provision of case management services for people living with HIV/AIDS throughout the state. The Community Follow-Up Program (CFP), providing intensive case management for HIV-positive individuals and their families, operates under the auspices of the Case Management Section. This article focuses on a public/private outcomes assessment partnership, sponsored by the Case Management Section, and developed in conjunction with a team of CFP programme managers from across the state. The process used to develop outcome indicators and measures is described; challenges encountered along the way are detailed; and suggestions for other public/private partnerships are outlined. Results from two years of outcomes data collection are also presented. The article concludes that the inclusion of providers in the identification and measurement of desired outcomes can help overcome provider resistance to outcomes assessment and can help ensure that outcomes data are used to improve programme performance.

The Impact of Managed Care on Efforts to Prevent Development of Serious Emotional Disturbance in Young Children

The purpose of this article is to present selected findings from a case study of systemic facilitators of, and barriers to, full implementation of Project Success. This project was designed to prevent the development of serious emotional disturbance (SED) in at-risk children in the early elementary grades. The project involved (1) an intervention composed of classroom interventions, use of multiple services located on school grounds, and provision of case management services to the children and their families; and (2) a qualitative case study of systemic facilitators and barriers regarding implementation of the intervention. This article focuses on the second component, specifically on how and why the move toward managed care in provision of mental health services in general and in the Medicaid program in particular frustrated efforts to prevent the development of SED in young children with existing emotional and behavioral problems.

Systematic Monitoring of the Implementation of a Case Management Model

A systematic approach for monitoring case management service provision and the results obtained when this approach was applied to a program for community-dwelling elders with severe mental illness are presented. A detailed, closed-ended, daily service log was used to collect data on 713 client-contact days. Participants (N = 24) were predominantly female (71%), were White (63%) or African American (37%), and tended to have diagnoses of either schizophrenia (42%) or major depression (21%). Services were delivered most frequently in the client's home (47%), the program office (35%), or by phone (27%); most frequent activities were monitoring psychiatric symptoms/medications (62 %), and monitoring physical symptoms or medications or both (54%). Service characteristics did not differ with regard to demographics but did vary with living situation and psychiatric diagnosis. The findings point to the need for flexible programs capable of meeting diverse service needs as well as the utility of a daily service log in studying case management.

The relationship of client characteristics to case management service provision: Implications for successful system implementation

The research reported here was part of an evaluation of the Mississippi case management system for the chronically mentally ill (CMI). The present study assessed the relationship between client characteristics and the amount of service time provided by case managers. Subjects were 2,152 CMI clients served by the case management system at 16 sites. The results suggest that factors other than the clients' overall functional level and the number and severity of their problems were used to determine service time provided to clients. Possible explanations for these findings are proposed, and the implications of the findings for the success of the case management system's implementation are considered.

Case management service provision and client change.

The present study examines the relationship between case management service provision to the chronically mentally ill and consequent client change. Subjects were clients who had been in the Mississippi case management system for at least six months. It was predicted that the services of linkage/referral and advocacy would account for the most change in the number of problems and severity of problems on the part of the client. However, less than three percent of the variance in overall client change was explained by all five services combined. Results are discussed in light of certain constraints within the system.