Receiving Case Management Research Articles

Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study.

BackgroundPatient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized.ObjectiveThe purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina.MethodsWe conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses.ResultsMost patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload.ConclusionsPatients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients.

Predictive Model-Driven Hotspotting to Decrease Emergency Department Visits: a Randomized Controlled Trial.

Emergency department (ED) visits contribute substantially to health care expenditures. Case management has been proposed as a strategy to address the medical and social needs of complex patients. However, strong research designs to evaluate the effectiveness of such interventions are limited. To evaluate whether a community-based case management program was associated with reduced ED utilization among complex patients. Patients whose risk exceeded a threshold were randomly assigned to a group offered case management or to the control group. Assignment occurred at five intervals between November 2017 and January 2019. Program effectiveness for all assigned patients was assessed using an intention-to-treat effect. Program effectiveness among those who received treatment was assessed using a local average treatment effect, estimated using instrumental variables. Both estimators were adjusted for baseline characteristics using linear models. Adults over age 18 with at least one health care encounter with Michigan Medicine or St. Joseph Mercy Health System between June 2, 2016, and November 27, 2018. Intervention arm participants (n = 486) were offered coordinated case management across medical, mental health, and social service organizations. Control arm participants (n = 409) received usual care. The primary outcome was the number of ED visits in the 6 months following randomization into the study. Secondary outcomes were 6-month counts of inpatient and outpatient visits. Of the 486 patients assigned to the intervention, 131 (27%) consented to receive case management. The intention-to-treat effect on ED visits was + 0.14 (95% CI: - 0.27 to + 0.55). The local average treatment effect among those who consented and received case management was + 0.53 (95% CI: - 1.00 to + 2.05). Intention-to-treat and local average treatment effects were not significant for secondary outcomes. The community case management intervention targeting ED visits was not associated with reduced utilization. Future case management interventions may benefit from additional patient engagement strategies and longer evaluation time periods. Clinicaltrials.gov Identifier: NCT03293160.

Case management after acquired brain injury compared to care as usual: study protocol for a 2-year pragmatic randomized controlled superiority trial with two parallel groups

BackgroundPeople with acquired brain injury may suffer from cognitive, emotional and behavioural changes in the long term. Continuity of care is often lacking, leading to a variety of unmet needs and hindering psychosocial functioning from the occurrence of brain injury up to years thereafter. Case management aims to prevent (escalation of) problems and to facilitate timely access to appropriate services. In other populations, case management has shown to improve psychosocial well-being. In this study, we aim to evaluate the feasibility of case management after acquired brain injury and its effectiveness and cost-effectiveness, compared to care as usual.MethodsThis is a pragmatic randomized controlled superiority trial with two parallel groups and repeated measures in adults with ABI and their family, taking place between November 2019 and December 2021 in three provinces in the Netherlands. Participants will be randomly allocated to either the case management group, receiving case management from hospital discharge up to 2 years thereafter, or the control group, receiving care as usual. Effectiveness will be evaluated every 6 months for 18–24 months by patient-reported psychosocial well-being (Hospital Anxiety and Depression Scale (HADS), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) restriction subscale and the Life Satisfaction Questionnaire (LiSat)), self-management (Patient Activation Measure (PAM)) and care needs (Longer-term Unmet Needs after Stroke (LUNS)). Family outcomes include self-efficacy (Carer Self-Efficacy Scale (CSES)), caregiver burden (Caregiver Strain Index (CSI)), psychosocial well-being (LiSat, HADS), family needs (Family Needs Questionnaire (FNQ)). Feasibility will be evaluated using qualitative methods, assessing fidelity, dose delivered, dose received, reach, recruitment and context. Cost-effectiveness will be determined by the EQ-5D-3L and service use.DiscussionAt the moment, there is no integrated health care service for people with acquired brain injury and their family members in the long term. If case management is shown to be feasible and (cost)-effective, it could bridge the gap between patients’ and families’ needs and the available services.Trial registrationNetherlands Trial Register NL8104. Registered on 22 October 2019.

Applying the eight principles of developmental evaluation: Complex Care Hub as a case example

Evaluators learning about developmental evaluation (DE) may struggle with the need for guidance on the concrete specifics of how to “do developmental evaluation” because of the need to tailor the use of the method to the context of the program being evaluated. Case examples in the literature provide illustrations of how others have applied this approach. This article adds to this growing body of knowledge by detailing the experience of the first year of a multiyear developmental evaluation of Complex Care Hub. This healthcare program is a hospital-at-home model where patients receive hospital-level services but sleep in their own home and receive case management as needed. The article ends with a discussion of challenges and lessons learned.

Is intensive case management screening sheet score associated with service intensity?

AimsSince April 2020, the new Japanese mental health system has used the Intensive Case Management Screening Sheet (ICMSS) to identify patients’ needs for case management services. This study aimed to examine the association between ICMSS score and service intensity and compare the magnitude of association between ICMSS score and service intensity with other scales.MethodsWe recruited patients who received case management services from a staff member in a psychiatric outpatient service, psychiatric day‐care program, or outreach team based at one psychiatric hospital. Case management service needs and functioning were assessed using ICMSS, Global Assessment Functioning (GAF), and Personal and Social Performance (PSP). The case manager also documented all services received by the participant for 2 months. The association between each scale and service duration was examined. Furthermore, the magnitude of the association between each scale and service intensity was compared.ResultsOverall, 138 participants were included in the analysis. The most common diagnosis was schizophrenia. Mean total service duration was weakly but significantly correlated with ICMSS (Spearman's ρ = 0.320), GAF (ρ = −0.198), and PSP (ρ = −0.275) scores. Poisson's regression models and postestimation testing showed that the coefficient for ICMSS score (B = 0.144; 95% CI = 0.141, 0.148) was significantly larger than the coefficients for GAF (B = −0.017, 95% CI = −0.017, −0.016, χ2 = 15.70, P < 0.001) and PSP (B=−0.016, 95% CI = −0.017, −0.016, χ2 = 14.64, P < 0.001) scores.ConclusionICMSS may provide preliminary information on case management service needs, but the level of service should be based on the individual needs of each patient and shared decision‐making between the patient and case manager.

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.

Emergency department utilization of case-managed patients following benign gynecologic surgery

BackgroundCase management has been shown to reduce the amount of unnecessary emergency department visits among Medicaid or uninsured patients. This study aims to determine whether case management is associated with decreased unnecessary emergency department visits among benign gynecology surgical patients in the first 30 days following surgery.ResultsOut of 875 patients, there were a total of 58 return visits to the emergency department within 30 days and only 6 readmissions. Twenty-four emergency department visits occurred in the case-managed group, and thirty-eight emergency department visits occurred in the non-case-managed group. The two factors that were statistically significant for increase odds of return to the emergency department were the type of surgery (inpatient versus outpatient) and case management. The odds for returning to the emergency department for those not receiving case management was found to be 4.53 to that of the case-managed group when controlling for BMI, age, marital status, and type of surgery.ConclusionIn an effort to reduce healthcare costs, case management is a promising intervention to help postoperative patients manage their care while minimizing emergency department visits.

Cost and health effects of case management compared with outpatient clinic follow-up in a Dutch heart failure cohort.

AimsHeart failure reduces quality of life and life expectancy; hospital admissions are frequent and create a burden on public resources. This study aims to quantify the benefits in terms of health effects [quality‐adjusted life years (QALYs)] and costs when heart failure patients receive case management at home compared with outpatient cardiology clinic follow‐up.Methods and resultsA health state transition (Markov) model was written, and transition probabilities were derived from a cohort of 1114 patients and available literature. QALYs in different health states of heart failure patients were retrieved from the literature, and costs were estimated with data from the financial department of the Noordwest Ziekenhuisgroep and public cost sources. Monthly simulation cycles were repeated 60 times to generate 5 years of virtual follow‐up data. Baseline willingness to pay is assumed €50 000 per QALY. Sensitivity analyses were performed in a one‐way deterministic and a multiway probabilistic approach; the probabilistic approach used uniform and more plausible distributions of the model parameters.Case management reduced costs by €382 and increased QALYs by 0.261 for the baseline simulation; this results in a net monetary benefit of €13 428. Probabilistic sensitivity analysis based on uniform and most plausible distributions of parameters resulted in 96.2% and 83.3% of the simulations, favouring a treatment strategy of case management.ConclusionsCase management is cost effective in 83.3% of the probabilistic simulations and has a tendency towards reducing costs and increasing QALYs when considering a real‐world cohort of heart failure patients in the Netherlands.

Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification.

Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.

Efficacy of a reminiscing and emotion training intervention on maltreating families with preschool-aged children.

The current investigation reports the results of a randomized controlled trial of a brief, relational intervention for maltreated preschool-aged children and their mothers, called Reminiscing and Emotion Training (RET). RET facilitates elaborative and emotionally supportive parent-child communication, which is an essential component of the parent-child relationship and is especially relevant for the preschool age period. Participants were 248 children between the ages of 3- to 6-years-old and their mothers. Following a baseline assessment, 165 maltreating families were randomized into RET or a Community Standard (CS) condition in which families received case management and written parenting information; 83 families participated in the nonmaltreating comparison condition. Results indicated that the key mechanisms targeted by the RET interventions were enhanced, such that mothers who participated in RET were significantly better in elaboration and sensitive guidance during reminiscing at the posttest than were maltreating mothers who did not receive the intervention, with medium to large effect sizes; additionally, mothers in the RET group were more elaborative than mothers from the nonmaltreatment group. Children in the RET condition also contributed significantly more memories and had better emotional knowledge than did children in the CS condition, controlling for baseline values and language, and approximated the functioning of nonmaltreated children. These findings add to a growing literature underscoring the benefits of brief, focused, relational interventions for maltreated children and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals

Purpose Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. Materials and methods Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). Results Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71–77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. Conclusions Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care. IMPLICATIONS FOR REHABILITATION Older adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores. Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support. Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained.

Navigating costs of care in women with breast cancer: Examining racial differences in non-treatment costs and financial toxicity in under-resourced populations struggling to afford medical care.

156 Background: Patients with cancer struggle to afford needed medical care alongside daily financial obligations due to rising healthcare costs. This may be more pronounced among minorities who are less likely to seek resources to mitigate their financial distress. This study sought to identify racial differences in non-treatment costs for under-resourced women with breast cancer who sought assistance from Patient Advocate Foundation (PAF). Methods: This cross-sectional study utilized secondary survey data collected from breast cancer patients receiving case management services from PAF in 2018. Respondents answered questions describing their financial distress and COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 267 breast cancer patients surveyed, 54% were Caucasian, 29% were African American (AA), and 83% indicated a household income of &lt; $48,000. Cohorts expressed strong dissatisfaction with their financial situation with AA impacted more acutely (78% vs 56%) and acknowledged inability to pay for treatment costs (83% vs 58%). Compared to Caucasians, AAs were more often concerned with transportation costs (33% vs 16%) and with day-to-day living expenses (83% vs 59%). Younger (≤55 years) AA respondents were twice as often unable to meet monthly expenses (60% vs. 27%). Older AA respondents ( &gt; 55 years) reported greater distress than older Caucasians (74% vs 57%), while younger Caucasians reported greater distress than their AA counterparts (72% vs 65%). COST scores differed significantly between Caucasians (mean 13, SD 9) and AAs (mean 11, SD 8; p = 0.04). Conclusions: While the impacts of medical care costs were felt by all survey respondents, under-resourced AA breast cancer patients may be at higher risk for household material hardships as financial resources are diverted toward essential healthcare costs.

Addressing Spiritual and Religious Influences in Care Delivery.

The impact of spiritual and religious factors on health and care delivery has been identified in case management field research. The purpose of this article is to examine how case managers, taking a holistic, patient-centered approach, are required under professional and ethical standards to address the spiritual and religious influences that may impact the individual's health, care choices, and care delivery. Case managers across health or human services must be able to identify and address the spiritual and/or religious factors that may influence a care plan and care delivery. This includes case managers in acute care, primary care, workers' compensation, hospice, mental health counseling, and other practice settings. Regardless of their professional discipline, specialization, or practice setting, case managers must ensure that the voice of the individual is heard and that each person receives the support that is most relevant and meaningful. The impact of spiritual and religious factors on health and care delivery has been identified in case management field research, known as role and function studies, which are conducted every 5 years, and which set the blueprint for the Certified Case Manager (CCM) certification examination. The most recent role and function study affirmed the knowledge domain of multicultural, spiritual, and religious factors that may affect the health status of the individual receiving case management services. Essential activities of case management include identifying multicultural, spiritual, and religious factors that may affect the client's health status and incorporating the effects of the client's multicultural, spiritual, and religious factors in the development of the plan of care and service delivery (). To demonstrate competency in the required knowledge domain and essential activities, case managers must be able to identify and address the spiritual and/or religious factors that may influence a care plan and care delivery.

The impact of integrated disease management in high-risk COPD patients in primary care

Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care. This was a one-year multi-center randomized controlled trial. High-risk, exacerbation-prone COPD patients were randomized to IDM provided by a certified respiratory educator and physician, or usual physician care. IDM received case management, self-management education, and skills training. The primary outcome, COPD-related QoL, was measured using the COPD Assessment Test (CAT). Of 180 patients randomized from 8 sites, 81.1% completed the study. Patients were 53.6% women, mean age 68.2 years, post-bronchodilator FEV1 52.8% predicted, and 77.4% were Global Initiative for Obstructive Lung Disease Stage D. QoL-CAT scores improved in IDM patients, 22.6 to 14.8, and worsened in usual care, 19.3 to 22.0, adjusted difference 9.3 (p < 0.001). Secondary outcomes including the Clinical COPD Questionnaire, Bristol Knowledge Questionnaire, and FEV1 demonstrated differential improvements in favor of IDM of 1.29 (p < 0.001), 29.6% (p < 0.001), and 100 mL, respectively (p = 0.016). Compared to usual care, significantly fewer IDM patients had a severe exacerbation, −48.9% (p < 0.001), required an urgent primary care visit for COPD, −30.2% (p < 0.001), or had an emergency department visit, −23.6% (p = 0.001). We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and HSU, in a high-risk primary care COPD population. Clinicaltrials.gov NCT02343055.

Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis.

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis.Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists.Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders.Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis.

Depression, ART Adherence, and Receipt of Case Management Services by Adults with HIV in North Carolina, Medical Monitoring Project, 2009-2013.

Depression among persons with HIV is associated with antiretroviral therapy (ART) interruption and discontinuation, virological failure, and poor clinical and survival outcomes. Case management services can address needs for emotional counseling and other supportive services to facilitate HIV care engagement. Using 2009-2013 North Carolina Medical Monitoring Project data from 910 persons engaged in HIV care, we estimated associations of case management utilization with "probable current depression" and with 100% ART dose adherence. After weighting, 53.2% of patients reported receiving case management, 21.7% reported depression, and 87.0% reported ART adherence. Depression prevalence was higher among those reporting case management (24.9%) than among other patients (17.6%) (p < 0.01). Case management was associated with depression among patients living above the poverty level [adjusted prevalence ratio (aPR), 2.05; 95% confidence interval (CI) 1.25-3.36], and not among other patients (aPR, 1.01; 95% CI 0.72-1.43). Receipt of case management was not associated with ART adherence (aPR, 1.00; 95% CI 0.95-1.05). Our analysis indicates a need for more effective depression treatment, even among persons receiving case management services. Self-reported ART adherence was high overall, though lower among persons experiencing depression (unadjusted prevalence ratio, 0.92; 95% CI 0.86-0.99). Optimal HIV clinical and prevention outcomes require addressing psychological wellbeing, monitoring of ART adherence, and effective case management services.

Social and economic impact of a case management approach for people with rare and complex conditions in Salaj, Romania

Background: Over 36 million people in Europe (patients and families) are affected by a rare disease (RD). Often not sufficiently supported by mainstream social systems, they struggle to make the most of their potential throughout their life course. Additionally, caregivers assisting their family member may find providing care over the long term challenging. A recent survey by EURORDIS-Rare Disease Europe showed that many caregivers (30%) spend more than six hours daily helping the patients. For 52%, the RD had a severe or very severe impact on their daily lives, and the time dedicated to coordination of care was substantial both for the patients themselves and their caregivers. The INNOVCare project, co-funded by the European Union, suggests implementation of integrated and patient-centred care pathways. These pathways involve linking health services to social and support services that RD patients use on a daily basis. In a current pilot project in Salaj, Romania, four case managers provide individualised guidance to coordinate the services for the user, to delineate a personalised pathway for each patient and to create effective changes in patients’ autonomy and daily lives. Our study aims to analyse the social and economic impact of this project, including both resource consumption and potential improvements in patients’/families’ quality of life. Methods: 120 patients with RD were randomly assigned to case managers for nine months in two cohorts. The first cohort will receive case management support for nine months whereas the control group usual treatment. After nine months the groups will be rotated. Data collection started in March 2017 through questionnaires to patients and their families distributed before, after nine months, and after 18 months using the same measurement tools. The questionnaires cover socio-economic status; patients’ condition, level of disability, and estimation of need; use of health, social and local services, health-related quality of life; work situation; and caregiver burden. Preliminary results: Patients’ mean EQ VAS score was 53.3 at baseline. The majority reported any problems in all dimensions with pain/discomfort and mobility being the most prominent. After 9 months, the mean scores were 54.0 and 62.0 for the 1st and 2nd cohort, respectively. Patients reported most problems in mobility and pain/discomfort (1st cohort) compared to usual activities and anxiety/depression (2nd cohort). Caregivers reported a mean EQ VAS score of 74.2 at baseline. At follow-up, the mean scores were 83.9 and 80.8 with the highest prevalence of problems reported in the dimensions pain/discomfort and anxiety/depression. ZBI scores showed a reduction from baseline to first follow-up. Mean ZBI (Zarit Caregiver Burden Interview) was 13.2 at baseline compared to 12.0 (1st cohort) and 12.3 (2nd cohort) at follow-up. Data analysis is ongoing and more results will be presented at the conference. Conclusions: Preliminary results from the 9-months follow-up suggest a positive impact mainly on the caregivers. However, by achieving coordinated and more person-centred care, the social inclusion will improve both for the patients and for their caregivers, which will hopefully lead to a reduced caregiver burden and less anxiety, stress, and financial pressure.

Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis

BackgroundMedicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS.MethodsWe used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures.ResultsBlack HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest.ConclusionsFindings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.

Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis

The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.

The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service

ABSTRACTLess is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use.Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.