Longitudinal study of symptom control and quality of life indicators with patients receiving community-based case management services

Demand for community-based Case Management in Austria - a qualitative analysis

Background

The 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.

Methods

A 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.

Results

The 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.

Conclusions

Care 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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00775-0.

Transition From Hospital to Home: The Role of the Nurse Case Manager in Promoting Medication Adherence in the Medicare Population

Lack of adherence to medication plans is a factor in costly hospital readmissions. Adherence to medication plans in the home care setting in relation to hospital readmission is a major issue among the Medicare population. Nurse case managers are in a key position to provide care after hospital discharge to promote medication adherence and thus reduce the chance of hospital readmission. This article discusses barriers to taking medications as prescribed and directed, the importance of ongoing medication reconciliation at home, and strategies to promote adherence to medication plans.

Case management effectiveness in reducing hospital use: a systematic review

AIM

This systematic review synthesizes recent evidence of the effectiveness of case management in reducing hospital use by individuals with chronic illnesses.

BACKGROUND

Hospital use by individuals with chronic illnesses accounts for 66% of healthcare costs in the United States. its has been cited as care coordination that can reduce healthcare costs; however, its effectiveness in improving hospital use outcomes is contradictory, and no review has yet synthesized recent studies of case management with respect to hospital use outcomes.

METHODS

This systematic review followed the Cochrane processes and was guided by use of PRISMA statements. Five electronic databases were searched to obtain randomized controlled trials published within the last 10 years that evaluated case management hospital use as a primary outcome by individuals with chronic illnesses.

RESULTS

Ten studies published between 2007 and 2015 were retrieved and assessed for risk of methodological bias. All studies used case management as an intervention, focused on transitional care services and reported hospital use, including readmissions and emergency department and hospital visits, as a primary outcome. Analysis of the studies showed that case management greatly reduced hospital readmissions and emergency department visits.

LIMITATIONS

Only studies published in English were searched, and retrieved studies tended to report positive results.

CONCLUSIONS

There was strong evidence of significant reductions in hospital use with case management as an intervention. However, other results about the efffectiveness of case management remain mixed; more rigorously designed studies with case management interventions are needed.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The complexity and cost of chronic illnesses means that case management should be considered as a tool to improve quality of care and lower healthcare costs.

Community-Based Case Management, Hospital Utilization, and Patient-Focused Outcomes in Medicare Beneficiaries

There is limited research about the impact of community-based case management (CBCM) services and its outcomes with longitudinal analysis. The purpose of this study was to evaluate the effectiveness of a CBCM intervention on patient outcomes in Medicare beneficiaries with chronic illness in a CBCM service in the rural Midwest. A descriptive, repeated-measures design was used, and a secondary analysis of a data set containing longitudinal CBCM data, originally collected from 2002 to 2007, was conducted. Two years of case management (CM) interventions, three health-service utilization outcomes, and three patient-focused outcomes were examined. The study findings showed that a CBCM had significant effect on reducing patients’ number of hospitalizations and increasing patients’ symptom control and quality of life. The impact of CM on length of stay and emergency department visits was indeterminate. Findings suggest that CBCM can be used as an effective intervention program for Medicare beneficiaries.