Role Of Case Manager Research Articles

Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada

BackgroundCase management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services.MethodsA qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out.ResultsLeadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an “individualized services plan” with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers’ concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care.ConclusionResults of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.

The therapy capability framework and mapping process: perspectives of mental health clinical case managers

ABSTRACT Objective: The aim of this study was to investigate the utility of a workforce leadership initiative, the Therapy Capability Framework (TCF), designed to enhance the provision of evidence-informed psychosocial therapies by publicly funded mental health case managers. To understand the experiences and perceptions of ‘first-time users' of the TCF was conceived as an important first step to help guide service-wide implementation. Method: In 2018, a qualitative descriptive research methodology using two in-depth focus groups with frontline mental health clinicians in case management roles was adopted to explore their perceptions and experiences of the TCF and TCF Process across Metro South Addiction and Mental Health Services in Brisbane, Australia. An inductive approach to thematic analysis guided the generation of themes and subthemes. Results: Participants understood the purpose of the TCF; however, they identified several factors influencing their experience, including specific features of the framework; how it was used; and organisational, workforce, and leadership factors that restricted its potential utility and impact. Discussion: Clinicians reported the TCF as having the potential to facilitate incremental change in the existing case management model. This paper represents a phase of evaluation and continuous improvement of the TCF, which can assist publicly funded mental health leaders to augment the provision of evidence-informed psychosocial therapies.

Understanding COPD Emergency Department presentations: using thematic analysis to explore the voices of patients, nurses, and doctors on the lived experience of managing COPD

Aim: To describe for areas of improvement in the management of COPD and reduction in emergency department presentations in Queensland. Background: If current trends in the management of COPD do not change, the predicted 4.5 million Australians diagnosed with COPD by 2050 will place significant burdens on already over-utilised frontline ED services. Separately COPD is more costly per case than cardiovascular disease and is a more common presentation to Emergency Departments in any year than most types of cancer, road traffic accidents and heart disease. Study Design and Methods: This study used a qualitative thematic analysis methodology in which field convergent interviews were employed to generate data. Sixteen staff and nine patients across three major Southern Queensland Health acute care facilities participated in the study. The authors analysed interview data using qualitative thematic analysis. Results: This research has revealed several noteworthy concepts worthy of further exploration. Thematic analysis from both staff and patient interviews identified the following issues: 1. Nurse case management, 2. Integrated communication of patient assessment and history data, 3. Failure in COPD management, and 4. Knowledge utilisation among ED clinicians. Inherent among these key concepts is a primary goal of coordinated congruent COPD management that optimise a patient’s functional status and quality of life, improving symptoms management, and avoiding recurrent exacerbations. Discussion: These insights into the experience of patients and hospital staff into the management of COPD provides valuable insight into current and desired practices that can help to minimise presentations to Emergency Departments. The findings of the research provide insights and future direction for improvements by addressing the inconsistency in disease management. The need for more accessible and consistent patient management and a more congruent centralised patient support framework was also identified. Conclusion: There is indication of support stemming from the voices of patients and hospital staff around the need for COPD case management to become the dominant method of care. Future research should consider the cost benefit and patient outcomes of the implementation of such a role and the avoidance of ED presentations. Implications for research, policy, and practice: The findings of this research imply a need to streamline the patient support and disease management discharged planning process by ensuring one health professional maintains ongoing education, support, and assessment to the patient. Future research needs to better ascertain the positive economic benefits to healthcare organisations by employing Case Managers for patients with COPD. What is already known about the topic? Case management roles can be effective in reducing ED usage for adults with chronic illnesses. The World Health Organization (WHO) has called for planned ongoing assessment, care and support coordinated by a proactive investment in real time solutions that address the increasing burden of this disease on the healthcare sector. The WHO has endorsed targeted patient support strategies that coordinate care over time, addressing the physical and mental health needs of people with chronic illness. What this paper adds: Findings from this research show that discharged planning support practices with Southern Queensland Healthcare Organisations require review and ongoing evaluation. This may include, streamlining the patient support and disease management discharged planning; or designated case management or integration of systems to prevent ED presentations. This research adds to the voices of patients and staff that confirm published research recommendations.

The Role of Case Manager and the Implementation in Supporting Patient-Centered Care in PKU Muhammadiyah Yogyakarta Hospital

The Role of Case Manager and the Implementation in Supporting Patient-Centered Care in PKU Muhammadiyah Yogyakarta Hospital

Prescribing Exercise to Cancer Patients Suffering from Increased Bone Fracture Risk Due to Metastatic Bone Disease or Multiple Myeloma in Austria—An Inter- and Multidisciplinary Evaluation Measure

In the current absence of specific functional fracture risk assessment technology, the planning of physical exercise interventions for cancer patients suffering from increased bone fracture risk remains a serious clinical challenge. Until a reliable, solely technical solution is available for the clinician, fracture risk assessment remains an inter- and multidisciplinary decision to be made by various medical experts. The aim of this short paper is depicting how this challenge should be approached in the clinical reality according to Austrian experts in cancer rehabilitation, presenting the best-practice model in Austria. Following referral from the specialist responsible for the primary cancer treatment (oncologist, surgeon, etc.), the physiatrist takes on the role of rehabilitation case manager for each individual patient. Fracture risk assessment is then undertaken by specialists in radiology, orthopedics, oncology, and radiation therapy, with the result that the affected bone regions are classified as being at highly/slightly/not increased fracture risk. Following internal clearance, exercise planning is undertaken by a specialist in exercise therapy together with the physiatrist based on the individual's fracture risk assessment. In the case in which the patient shows exercise limitations due to additional musculoskeletal impairments, adjuvant physical modalities such as physiotherapy should be prescribed to increase exercisability. Exercise prescription for cancer patients suffering from increased fracture risk is an inter- and multidisciplinary team decision for each individual patient.

Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia

BackgroundReconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning.MethodsA multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses.ResultsOne-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each.ConclusionsStrong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost–benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.

Knowledge about monkeypox viral infection among pediatric residents in Saudi Arabia

Background: The new resurgence of human Monkeypox (Mpox) cases, both within and outside of the central and western African countries, is causing concern among public health officials worldwide. Pediatric physicians play an important role in Mpox surveillance and case management; thus, this study aims to determine the level of Mpox knowledge among pediatric residents in Saudi Arabia. Methods: A cross-sectional study was done from November 21 to December 28, 2022, in Riyadh, the capital of Saudi Arabia involving 128 pediatric residents' physicians chosen through systematic random sampling. A validated, semi-structured, self-administered questionnaire was used to collect data. R-software was used to analyze the data. The chi-square test was used to investigate the relationship between the knowledge score and the sociodemographic independent variables. Results: Among the 128 pediatric residents' physicians who participated in this study, the majority (65.7%) were aged >26 years. More of the respondents were female (57%), married (63.2%), and in their junior level of residency years (48.4%). The majority (66%) of the respondents have good knowledge of Mpox. Being a senior resident, getting a full dose of COVID-19 vaccines, and having recently heard about Mpox outbreaks were statistically significant factors associated with good scores in knowledge about Mpox. The main sources of information were medical education, radio, television, and newspaper. Conclusions: Despite the adequate level of knowledge about the Mpox gap among pediatric residents' physicians, it is recommended that targeted intervention could be a channel through organized continuous medical education and social media to improve the knowledge about any new emergent diseases.

Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.

Professional Case Management in Outpatient Settings for Patients With Myeloproliferative Neoplasms.

The purpose of this discussion is to review the management and symptomatic burden of patients with myeloproliferative neoplasms (MPNs). Patients with MPNs are at increased risk for thromboembolic events; thus, cardiovascular complications are not uncommon. Professional case managers can coordinate outpatient services with the health care team and assist patients to mitigate cardiovascular complications. This discussion is relevant to professional case managers who manage patients with chronic conditions in outpatient settings. Professional case managers can intervene for patients with MPNs to improve (a) coordination of scheduled therapeutic phlebotomy procedures, and (b) education about subcutaneous injections and frequent monitoring of laboratory reports. In the outpatient setting, professional case managers can improve health care utilization for patients with MPNs and promote high-quality self-care and symptom management to prevent adverse complications. As a member of the outpatient health care team, the professional case manager can serve as a key clinician with comprehensive knowledge of the patient's experience of living with an MPN, their usual state of health and symptoms, and the factors affecting their quality of life. This article explores the role of the professional case manager in the outpatient setting and suggests specific interventions to improve delivery of care and contribute to better self-care management. Professional case managers can assess and validate symptom burden, coordinate and manage routine laboratory testing, support careful medication adjustment, and contribute to improved health outcomes.

The nurse anesthetist’s perception of the role of case manager in four provinces of Indonesia

Introduction Integrated and patient-focused healthcare is urgently needed, and there is an important role for case managers in implementing them. However, the understanding of healthcare providers, especially nurse anesthetists, about the role of case managers is still varied and is often considered only as a complement to hospital accreditation. This study aimed to determine the factors that influence the nurse anesthetist’s perception of the role of the case manager. Methods This cross-sectional study involved 369 nurse anesthetists who were selected using cluster sampling. Data collection was done using Google Forms. Furthermore, the data were analyzed using multiple logistic regression to identify the factors that influence the nurse anesthetists’ perception of the role of the case manager. Results From a total of 369 respondents, most (60%) have a positive perception of case managers. Marital status (AOR = 2.3; 95% CI: 1.27–4.15) and knowledge (AOR = 3.2; 95% CI: 2.03–5.07) were significant predictors of the nurse anesthetist’s perception of the role of the case manager. Discussion Even though the majority of nurse anesthetists have positive perceptions, socialization to increase knowledge about case managers is needed to reduce misperceptions about the role of case managers.

Nursing case management in the palliative care: Scoping review

Background & Aim: Palliative care is of vital importance for the quality of life of the person who benefits from it. Nursing case management provides useful tools for optimizing the care that is provided, thus being an important resource for improving them in an area as complex as palliative care. This study aimed to map scientific evidence on nursing case management in the context of palliative care.
 Methods & Materials: Scoping review was done according to the eligibility criteria suggested by Joanna Briggs Institute: population (adults who benefit from palliative care), concept (studies in which nursing case management is implemented), and context (studies in the palliative, hospital or home care). The research was conducted in CINAHL (via EBSCO), MEDLINE (via PUBMED), COCHRANE, Scielo, LILACS, and MedicLatina databases; grey literature was researched in RCAAP, DART-Europe, and OpenGrey. Previously published studies in Portuguese, Spanish, English, and French have been included without any temporal limitation.
 Results: We included ten articles in the review. Nursing case management is focused on health services management, the centrality of patient/family care, and the case manager role.
 Conclusion: The studies included have low evidence levels and a limited sample size. The optimization of resources and services, the greater availability of time for the provision of care, and the satisfaction of the person and family with the care were highlighted. The role of the case manager is highlighted, proving to be very important throughout all the nursing case management.

Enhancing Tobacco Treatment for Medicaid Recipients.

Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients. Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations. Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities. The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.

A Mathematical Model of Non-Clinical Case Management Hours in Student Affairs

Student affairs administrators in higher education spend time advocating for students in times of crisis. Whether case management occurs within a full-time case management role or as added responsibilities onto an administrator’s job, the hours and minutes spent helping students manage crises add up to a significant amount of time. This article presents a mathematical model for measuring time devoted to case management work among student affairs administrators (i.e., non-clinical case managers).

The dual diagnosis clinician shared care model – a clinical mental health dual diagnosis integrated treatment initiative

PurposeTo improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia.Design/methodology/approachDual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery.FindingsSince the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment).Originality/valueThe establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.

Challenges in inpatient care coordinators’ clinical workflow and opportunities in designing a health IT solution: A mixed methods study

Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.

Whose Outcome is it Anyway? Outcome and Brain Injury Case Management

<strong>Context:</strong> The acquired brain injury (ABI) literature highlights various factors that can prevent successful community rehabilitation and hinder good long-term outcomes. Brain injury case management is a service model with the potential to overcome these barriers within rehabilitation and longer-term care and support, but there is minimal research surrounding the effectiveness of case management in ABI. <strong>Objectives:</strong> This study aims to gain a better understanding of outcomes in brain injury case management and what facilitates good outcomes when working with clients from the perspective of brain injury case managers. <strong>Methods:</strong> A mixed qualitative study using both conventional content analysis and thematic analysis. Twenty-eight brain injury case managers completed an online questionnaire about what constitutes a good outcome in brain injury case management. Of these, five took part in a follow-up interview. <strong>Findings:</strong> The analysis identified four themes related to brain injury case management outcomes; 1) A client-centred approach to outcome, 2) the role of the brain injury case manager, 3) monitoring outcome in case management, and 4) issues of funding. <strong>Limitations:</strong> Participation in the survey and interviews was somewhat low, largely due to conducting the study during the COVID-19 pandemic. The study only included brain injury case mangers and future studies should examine clients’ and family members’ perspectives. <strong>Implications:</strong> This study identified that brain injury case management is a holistic approach to rehabilitation and case coordination that requires further attention to develop evidence-informed practice. Appropriate holistic measures of quality of life and outcome need to be developed to support the evidence base for case management.

“The role of case management in HIV treatment adherence: HPTN 078”

Adherence to care and antiretroviral therapy is challenging, especially for people living with HIV (PLWH) with additional co-occurring risk factors. Case management interventions, including motivational interviewing (MI), show promise to improve HIV treatment adherence, but few studies have examined how such interventions are delivered to or experienced by PLWH who have been reengaged in care. We conducted qualitative interviews with six case managers and 110 PLWH exiting from a randomized study (HPTN 078) who received a MI-based case management intervention in addition to standard patient-navigation services, or standard services only. Our study provided greater insight into the main findings from HPTN 078, including an in-depth description of the multiple barriers to adherence faced by this largely “out-of-care” population, as well as a more nuanced understanding of the benefits and challenges of implementing MI. A blend of MI plus more intensive interventions may be needed for PLWH facing multiple structural barriers.

Nurse Case Manager Lifestyle Medicine (NCMLM) in the Type Two Diabetes patient concerning post COVID-19 Pandemic management: Integrated-Scoping literature review.

The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quantitative data related to Nurse Case Management programs in Lifestyle Medicine view. Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.

Establishment of Role and Core Competencies of Geriatric Case Managers in Taiwan

Older adults have unique and complex care needs that are multifaceted, continuous, and integrated and that span prevention and treatment to long-term rehabilitation. Case managers are able to integrate healthcare and social resources to help older adults and their caregivers manage the needs of daily life. Therefore, identifying the role and core competencies of geriatric case managers in Taiwan is crucial. To develop the role and core competencies of geriatric case managers in Taiwan. Based on a review of the literature, a two-round modified Delphi technique was used to evaluate the framework of the geriatric case manager role and core competencies. Experts were invited to join a panel to review and rank the importance of each role and competency within the context of the Delphi technique. Four roles and 36 core competencies of geriatric case managers were identified, and 94.4% consensus was reached in round two. The roles and core competencies included care expert (18 competencies), coordinator (6 competencies), consultant (6 competencies), and evidence-based practitioner (6 competencies). Training programs may be developed for geriatric case managers based on the results of this study to further promote the quality of provided geriatric care.

The importance of social work roles in disaster risk management in Zimbabwe

This study was aimed at exploring the efficacy of social work roles in disaster risk management in Zimbabwe in the face of climatic changes. It was carried out in Binga district, Matebeleland-North province using the qualitative methodology and a case study design. The study sample was comprised of 8 practicing social workers. Snowballing and purposive sampling techniques were used to select these participants. Data were collected through in-depth interviews using an interview guide. Thematic content analysis was employed to analyze the collected data. It was found that social workers play essential roles before, during and after disasters. On disaster preparedness, it was established that social workers assume roles of educators, community workers and disaster planners. Moreover, it was found that they play the roles of case managers, administrators of social protection and counselors during the disaster response phase of disaster risk management. Subsequently they also act as advocates, development facilitators as well as monitoring and evaluation personnel in the disaster recovery phase. As per the findings, the study recommends that social workers be recognized as essential in disaster risk management at both policy and practice level. Further, there is need to enhance social work training education for flexibility and contextual application of social work knowledge in the field of disaster risk management for quality realization of green social work in Zimbabwe.