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Byhoff E, Rudel R, Taylor LA. Thoughtful Investing in Social Care Management: The Cause of, and Solution to, All of Life's Problems. J Ambul Care Manage 2024; 47:203-211. [PMID: 38771174 DOI: 10.1097/jac.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Elena Byhoff
- Author Affiliations: Division of Health Systems Science, Department of Medicine, Division of Health Information and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York.; Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Villarreal-Granda P, Recio-Platero A, Martín-Bayo Y, Durantez-Fernández C, Cárdaba-García RM, Pérez-Pérez L, Madrigal M, Muñoz-del Caz A, Olea E, Bahillo Ruiz E, Jiménez-Navascués L, Velasco-Gonzalez V. Models Used by Nurse Case Managers in Different Autonomous Communities in Spain: A Scoping Review. Healthcare (Basel) 2024; 12:749. [PMID: 38610172 PMCID: PMC11011987 DOI: 10.3390/healthcare12070749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The role of the nurse case manager is unknown to the population. The main objective is to analyze the existing differences within the national territory in order to make known the situation in Spain with a view to the recognition of its functions and the creation of the professional profile in an equal manner. (2) Methods: A scoping review was conducted in order to achieve the main aim. Selected articles were subjected to a critical reading, and the levels of evidence and grades of recommendation of the Joanna Briggs Institute were verified. The search field was limited to the last ten years. (3) Results: Case management models are heterogeneous in different autonomous communities in Spain. Case nurse management is qualified for high-complexity patients, follow up on chronic patients, and coordinate health assistance. (4) Conclusions: It concludes that nursing's role is crucial in the field of case management, being required in the follow-up of chronic patients of high complexity. Despite the proven health benefits, efficacy, and efficiency of case management, there are many heterogeneous models that coexist in Spain. This involves a restriction in the development of a nursing career because of the lack of a definition of its functions and competences.
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Affiliation(s)
- Paula Villarreal-Granda
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
| | - Amada Recio-Platero
- Unidad de Insuficiencia Cardiaca y Terapias Avanzadas, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Yara Martín-Bayo
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
| | - Carlos Durantez-Fernández
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
| | - Rosa M. Cárdaba-García
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
| | - Lucía Pérez-Pérez
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
- Primary Care Management Valladolid West (SACYL), 47012 Valladolid, Spain
| | - Miguel Madrigal
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
| | - Alba Muñoz-del Caz
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
- University Clinical Hospital of Valladolid, 47003 Valladolid, Spain
| | - Elena Olea
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Instituto de Biomedicina y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas, Universidad de Valladolid (UVa-CSIC), 47005 Valladolid, Spain
| | - Esther Bahillo Ruiz
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
- Nursing Department, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
| | - Lourdes Jiménez-Navascués
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
- Nursing Department, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
| | - Veronica Velasco-Gonzalez
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (P.V.-G.); (R.M.C.-G.); (L.P.-P.); (M.M.); (A.M.-d.C.); (E.O.); (V.V.-G.)
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain; (E.B.R.); (L.J.-N.)
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Gabet M, Armoon B, Meng X, Fleury MJ. Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review. Am J Emerg Med 2023; 74:1-8. [PMID: 37717467 DOI: 10.1016/j.ajem.2023.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Frequent emergency department (ED) users with mental health issues are particularly vulnerable patients, who often receive insufficient or inadequate outpatient care. This systematic review identified and evaluated studies on ED-based interventions to reduce acute care use by this population, while improving outpatient service use and patient outcomes. Searches were conducted in five databases for studies published between January 1, 2000, and April 30, 2022. Eligibility criteria included: patients with mental health issues who made 2+ ED visits in the previous 6 months or were high ED users (3+ visits/year), and who received ED-based interventions to reduce ED use. The review included 12 studies of 11,082 articles screened. Four intervention groups were identified: care plan (n = 4), case management (n = 4), peer-support (n = 2) and brief interventions (n = 2). The definitions of frequent users varied considerably, while the quality assessment rated studies from moderate to good and risk of bias from low to high. Eight studies used pre-post design, and four were randomized controlled trials. Ten studies assessed outcomes related to use of other services than ED, mainly hospitalizations, while five assessed patients' clinical conditions and three, social conditions (e.g., housing status). This review revealed that case management and care plan interventions, based in ED, decrease ED use among frequent users, while case management also showed promising results for outpatient service use and clinical and social outcomes. Thus, the results support continued deployment of intensive ED-based interventions for frequent ED users with mental health issues although firm conclusions regarding the effectiveness of these interventions, particularly outcomes related to services other than ED, require further investigation.
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Affiliation(s)
- Morgane Gabet
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada; Département de Gestion, Evaluation et Politique de Santé, Université de Montréal, Montréal, Canada
| | - Bahram Armoon
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada
| | - Xiangfei Meng
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada
| | - Marie-Josée Fleury
- Division of Mental Health & Society, Douglas Hospital Research Centre, Montreal, Canada; Département de Gestion, Evaluation et Politique de Santé, Université de Montréal, Montréal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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Fusetti V, Angi M, Caraceni AT, Di Guardo L, Regalia E, Bosisio M, Lo Dico S, Pigni A, Brunelli C, Lusignani M. Palliative Care Nursing Case Management in Young Adults With Advanced Rare Cancer: Case Discussion of a Multidisciplinary Approach. Prof Case Manag 2023; 28:280-287. [PMID: 37787706 DOI: 10.1097/ncm.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Purpose/Objectives:
This case aims to identify the elements of care continuity that are lacking in young adult patients with advanced rare cancer, suggesting ways to enhance continuity of care through nurse case manager/management (NCM) interventions and describing their impact on the emotional burden of patients and their families.
Primary Practice Setting(s):
Comprehensive cancer center.
Findings/Conclusions:
The dyadic care alliance with the NCM can alleviate disease burden, fostering trust in the team and adherence to care advice, thus reducing the patient's distress. The NCM can be an efficient option to advocate for patient needs on the multidisciplinary team, addressing practical issues and the unmet needs of patients and their caregivers, and facilitating referrals to other professionals. The study also shows that caring for young adults with advanced rare cancers should include mindful evaluation of their significant others.
Implications for Case Management Practice:
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Affiliation(s)
- Viviana Fusetti
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Angi
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Augusto T Caraceni
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenza Di Guardo
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Regalia
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Bosisio
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Lo Dico
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Pigni
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cinzia Brunelli
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maura Lusignani
- Viviana Fusetti, MSN, RN , is a case manager and nurse researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. She completed the MSN in research and management and is now attending the PhD in Nursing Science and Public Health. She is affiliated with Università degli Studi di Roma Tor Vergata, Rome, Italy, and National Cancer Institute, Milan, Italy
- Martina Angi, MD , is a medical doctor specialized in ocular oncology, is now hospital doctor in the Ocular Oncology Unit of the National Cancer Institute of Milan. She is expert in surgical treatment of uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Augusto T. Caraceni, MD , is a head physician of the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan, and director of the School of Specialization in Palliative Care Medicine of the Università degli Studi di Milano. He is also the cochairman of the European Center for Palliative Care Research. He is affiliated with National Cancer Institute, Milan, Italy, and Università degli Studi di Milano, Milan, Italy
- Lorenza Di Guardo, MD , is a medical doctor specialized in medical oncology and is now hospital doctor in the Medical Oncology Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment skin and uveal melanoma. She is affiliated with National Cancer Institute, Milan, Italy
- Enrico Regalia, MD , is a medical doctor specialized in surgery and medical oncology and is now hospital doctor in the HPD Surgery and Liver Transplantation Unit of the National Cancer Institute of Milan. He is expert in surgical treatment of liver cancer. He is affiliated with National Cancer Institute, Milan, Italy
- Marco Bosisio, PsyD , is a psychotherapist in the Clinical Psychology Unit of the National Cancer Institute of Milan. He serves as clinician, researcher, and member of the board of directors in the School of Psycho-oncology of the same institution. He is affiliated with National Cancer Institute, Milan, Italy
- Silvia Lo Dico, MD , is a medical doctor specialized in medical oncology. She is now hospital doctor in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She is expert in medical diagnosis and treatment of cancer-related symptoms management. She is affiliated with National Cancer Institute, Milan, Italy
- Alessandra Pigni, MD , is a medical doctor specialized in medical oncology. She is senior researcher at the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. Coinvestigator of several national and international institutional clinical trials, she performed didactic activity at university and on professional and institutional educational programs. She is affiliated with National Cancer Institute, Milan, Italy
- Cinzia Brunelli, PhD , is a statistician and senior researcher in the Palliative Care, Pain Therapy and Rehabilitation Unit of the National Cancer Institute of Milan. She completed PhD in palliative care and currently she is associated editor of the supportive and palliative care section of Tumori Journal . She is affiliated with National Cancer Institute, Milan, Italy
- Maura Lusignani, MSN, RN, is a head of the bachelor degree in nursing and president of the MSc in Nursing of the Università degli Studi di Milano. She directs many master courses with a focus on nursing leadership. Recently, she became full professor in nursing sciences in the same university. She is affiliated with Università degli Studi di Milano, Milan, Italy, and Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Shade K, Hidalgo P, Arteaga M, Rowland J, Huang W. Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project. Prof Case Manag 2023; 28:271-279. [PMID: 37787704 DOI: 10.1097/ncm.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE OF STUDY Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission. PRIMARY PRACTICE SETTING The setting was a vertically integrated health care system located in Northern California. METHODOLOGY AND SAMPLE This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic-clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre-/post-health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings. RESULTS Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).
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Affiliation(s)
- Kate Shade
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Paulina Hidalgo
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Manuel Arteaga
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Janet Rowland
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
| | - Winnie Huang
- Kate Shade, PhD, RN , is an assistant professor at Cal State East Bay and an adjunct associate professor at Samuel Merritt University. Dr. Shade has experience in public health case management and program evaluation. She has conducted research with youth involved in the juvenile justice system
- Paulina Hidalgo, MSN, RN , is a nurse case manager at Stanford Healthcare and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Manuel Arteaga, MSN, RN , is a pediatric nurse case manager at UCSF/Benioff Children's Hospitals and serves on the board of a federally qualified health center in the San Francisco Bay Area. Mr. Arteaga has experience as a case manager with the department of child support services and graduated with a master of science in nursing, case management from Samuel Merritt University in December 2021
- Janet Rowland, EdD, MSN, RN-BC, ACM-RN , is the assistant director of the case management program and an assistant professor at Samuel Merritt University. She holds certifications in case management from the ANCC and the ACMA. She has worked for over 25 years in care coordination and public health nursing and previously served in the US Army Nurse Corps
- Winnie Huang, MSN, RN, PHN , is currently working as an RN case manager at Northern California outside utilization review services with Kaiser Permanente. She has experience in clinical case management including leadership and education roles in various organizations
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Delahunty-Pike A, Lambert M, Schwarz C, Howse D, Bisson M, Aubrey-Bassler K, Burge F, Chouinard MC, Doucet S, Luke A, Macdonald M, Zed J, Taylor J, Hudon C. Stakeholders' perceptions of a nurse-led telehealth case management intervention in primary care for patients with complex care needs: a qualitative descriptive study. BMJ Open 2023; 13:e073679. [PMID: 37844984 PMCID: PMC10582901 DOI: 10.1136/bmjopen-2023-073679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE With the onset of the COVID-19 pandemic, telehealth case management (TCM) was introduced in primary care for patients requiring care by distance. While not all healthcare needs can be addressed via telehealth, the use of information and communication technology to support healthcare delivery has the potential to contribute to the management of patients with chronic conditions and associated complex care needs. However, few qualitative studies have documented stakeholders' perceptions of TCM. This study aimed to describe patients', primary care providers' and clinic managers' perceptions of the use of a nurse-led TCM intervention for primary care patients with complex care needs. DESIGN Qualitative descriptive study. SETTING Three primary care clinics in three Canadian provinces. PARTICIPANTS Patients with complex care needs (n=30), primary care providers (n=11) and clinic managers (n=2) participated in qualitative individual interviews and focus groups. INTERVENTION TCM intervention was delivered by nurse case managers over a 6-month period. RESULTS Participants' perceptions of the TCM intervention were summarised in three themes: (1) improved patient access, comfort and sense of reassurance; (2) trusting relationships and skilled nurse case managers; (3) activities more suitable for TCM. TCM was a generally accepted mode of primary care delivery, had many benefits for patients and providers and worked well for most activities that do not require physical assessment or treatment. Participants found TCM to be useful and a viable alternative to in-person care. CONCLUSIONS TCM improves access to care and is successful when a relationship of trust between the nurse case manager and patient can develop over time. Healthcare policymakers and primary care providers should consider the benefits of TCM and promote this mode of delivery as a complement to in-person care for patients with complex care needs.
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Affiliation(s)
- Alannah Delahunty-Pike
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mathieu Bisson
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Marilyn Macdonald
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. FRONTIERS IN HEALTH SERVICES 2023; 3:1211577. [PMID: 37654810 PMCID: PMC10465329 DOI: 10.3389/frhs.2023.1211577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Abstract
Background For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.
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Affiliation(s)
- Denise M. Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Dylan Waller
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Kristina M. Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn M. McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Perla
- Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States
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Yant B, Kromer L, Savage PD, Khadanga S, Ades PA, Gaalema DE. Financial incentives and case management to improve cardiac rehabilitation participation among patients with lower socio-economic status: Rationale and protocol for a randomized controlled trial. Contemp Clin Trials 2023; 129:107174. [PMID: 37019181 PMCID: PMC10225326 DOI: 10.1016/j.cct.2023.107174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Participation in phase 2 cardiac rehabilitation (CR) is associated with significant decreases in morbidity and mortality. Unfortunately, attendance at CR is not optimal and certain populations, such as those with lower-socioeconomic status (SES), are less likely to participate. In order to remedy this disparity we have designed a trial to examine the efficacy of early case management and/or financial incentives for increasing CR participation among lower-SES patients. METHODS We will employ a randomized controlled trial with a sample goal of 209 patients who will be randomized 2:3:3:3 to either a usual care control, to receive a case manager starting in-hospital, to receive financial incentives for completing CR sessions, or to receive both interventions. RESULTS Treatment conditions will be compared on attendance at CR and end-of-intervention (four months) improvements in cardiorespiratory fitness, executive function, and health-related quality of life. The primary outcome measures for this project will be number of CR sessions completed and the percentage who complete ≥30 sessions. Secondary outcomes will include improvements in health outcomes by condition, as well as the cost-effectiveness of the intervention with a focus on potential reductions in emergency department visits and hospitalizations. We hypothesize that either intervention will perform better than the control and that the combination of interventions will perform better than either alone. CONCLUSIONS This systematic examination of interventions will allow us to test the efficacy and cost-effectiveness of approaches that have the potential to increase CR participation substantially and significantly improve health outcomes among patients with lower-SES.
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Affiliation(s)
- Blair Yant
- University of Vermont, United States of America
| | - Lisa Kromer
- University of Vermont, United States of America
| | | | - Sherrie Khadanga
- University of Vermont, United States of America; University of Vermont Medical Center, United States of America
| | - Philip A Ades
- University of Vermont, United States of America; University of Vermont Medical Center, United States of America
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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10
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Hudon C, Bisson M, Chouinard MC, Delahunty-Pike A, Lambert M, Howse D, Schwarz C, Dumont-Samson O, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Scott C, Warren M, Wilhelm L. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res 2023; 23:377. [PMID: 37076851 PMCID: PMC10116737 DOI: 10.1186/s12913-023-09379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Case 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. METHODS A 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. RESULTS Leadership 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. CONCLUSION Results 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.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre Hospitalier Universitaire de Sherbrooke Research Centre, Sherbrooke, QC, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Olivier Dumont-Samson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Fred Burge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Judy Porter
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Cathy Scott
- Canadian Cancer Society, Toronto, ON, Canada
| | - Mike Warren
- Patient Advisory Council, Newfoundland and Labrador SPOR SUPPORT Unit, St. John's, NL, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
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11
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Hudon C, Chouinard MC, Dumont-Samson O, Gobeil-Lavoie AP, Morneau J, Paradis M, Couturier Y, Poitras ME, Poder T, Sabourin V, Lambert M. Integrated case management between primary care clinics and hospitals for people with complex needs who frequently use healthcare services: A multiple-case embedded study. Health Policy 2023; 132:104804. [PMID: 37028261 DOI: 10.1016/j.healthpol.2023.104804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Case management (CM) is recognized to improve care integration and outcomes of people with complex needs who frequently use healthcare services, but challenges remain regarding interaction between primary care clinics and hospitals. This study aimed to implement and evaluate an integrated CM program for this population where nurses in primary care clinics worked with a hospital case manager. METHODS A multiple embedded case study was conducted in the Saguenay-Lac-Saint-Jean region (Québec, Canada), in four dyads including a clinic and a hospital. Mixed data collection included, at baseline and 6 months, interviews and focus groups with stakeholders, patient questionnaires (patient experience of integrated care and self-management), and emergency department (ED) visits in the previous 6 months. RESULTS Integrated CM implementation was optimal when all stakeholders provided collective leadership, and were supportive of the program, particularly the physicians. The 6-month program enabled the observation of positive qualitative outcomes in most clinic-hospital dyads where implementation occurred. Full implementation was associated with improved care integration. DISCUSSION AND CONCLUSION Integrated CM between primary care clinics and hospitals is a promising innovation to improve care integration for people with complex needs who frequently use healthcare services. Collective leadership and physicians' buy-in to integrated CM are important to foster the implementation.
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12
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Nadolny S, Bruland D, Grunwald M, Gröndahl A, Grammatico J, Richter MT, Grebe C, Latteck ÄD. Case management and care expertise as a prevention approach for adults with intellectual disabilities (FaPP-MgB): study protocol for a randomized-controlled trial. Trials 2023; 24:136. [PMID: 36814350 PMCID: PMC9946867 DOI: 10.1186/s13063-023-07155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Adults with intellectual disabilities have a higher prevalence of unhealthy eating habits, stress, low levels of mobility, and comparable drug consumption as the general population. Consequently, they suffer from several chronic diseases earlier and more often, but there are fewer prevention and health promotion services including this population. The goal of this study is to determine if an advanced practice nursing approach in the community with home visits is an effective way to improve the health status of adults with intellectual disabilities. METHODS We will conduct a randomized-controlled trial with waiting list design in Hamburg, Germany. Inclusion criteria are diagnosis ICD F70-F79 and exclusion criteria are care level > 3 according to the German Social Code XI or being at the end-of-life. Participants will be block randomized. The intervention consists of advanced practice nurses performing case management, social space analysis, prevention planning, and counseling through four outreach home visits on nutrition, mobility, addiction, and stress. Comparison is usual care. The primary outcome is health status (WHODAS) after 12 months. Secondary outcomes are health-related quality of life (EQ-5D) and resilience (RS-11) after 6 and 12 months. The calculated sample size is 256 with an estimated dropout of 30%. Raters and analysts will be blinded. Analysis will be performed using ANCOVAs. DISCUSSION By providing case management and utilizing their nursing expertise, advanced practice nurses will provide valuable input and guidance on prevention and health promotion for people with intellectual disabilities. They will close the gap between health and social care, which is prominent in Germany, through cooperation between the existing care sectors. The findings will be disseminated in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION German Clinical Trials Register, DRKS00028771 , registered 4 July 2022, Universal Trial Number: U1111-1277-0595.
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Affiliation(s)
- Stephan Nadolny
- Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619, Bielefeld, Germany. .,Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
| | - Dirk Bruland
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Marie Grunwald
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany ,grid.434095.f0000 0001 1864 9826Institute for Management and Technology, Osnabrück University of Applied Sciences, Kaiserstraße 10C, 49809 Lingen, Germany
| | - Annika Gröndahl
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Jessica Grammatico
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Miriam Tariba Richter
- grid.11500.350000 0000 8919 8412Competence Center for Health, Hamburg University of Applied Sciences, Alexanderstraße 1, 20099 Hamburg, Germany
| | - Christian Grebe
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Änne-Dörte Latteck
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
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13
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Wu MC, Hung CC, Fang SC, Lee TSH. Change of home visit frequency by public health nurses predicts emergency escorts for psychiatric patients living in the community: A retrospective medical record review. Front Public Health 2023; 11:1066908. [PMID: 36844831 PMCID: PMC9948617 DOI: 10.3389/fpubh.2023.1066908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background Improper or insufficient treatment of mental health illness harms individuals, families, and society. When psychiatric treatment shifts from a hospital-based to a community-based health care system, risk management is essential to the provision of effective care. Objective We examine whether an upgrade in home visit frequency of psychiatric patients as identified by public health nurses can predict the subsequent need for emergency escort services for medical treatment. Design A 2-year retrospective medical record review. Settings A district of New Taipei City in Taiwan. Participants A total of 425 patients with a diagnosed mental health illness cared for through home visits by public health nurses from January 2018 to December 2019. Methods We accessed the Ministry of Health and Welfare's psychiatric care management information system to identify a set of medical records, and analyzed these records using chi-square and regression analyses. Results The analyses indicated that the groups experiencing the greatest need for emergency escort services were: male, 35-49 years old, with a senior high school level of education, without a disability identification card, with a schizophrenia diagnosis, and had been reported by the nurse as having progressed to a serious level. Nurses' increased frequency of home visits (an indicator that the patient's overall condition was worsening) and nurses' reports of increased severity of problems were significant predictors of the need for emergency escort services. Conclusions The nurses' adjustment of visit frequency based on the results of the visit assessment predicts the need for emergency escort services for mental patients. The findings support not only the professional roles and functions of public health nurses, but also the importance of strengthening psychiatric health community support services.
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Affiliation(s)
- Meng-Chieh Wu
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chun Hung
- Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan,Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan,*Correspondence: Tony Szu-Hsien Lee ✉
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14
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Joo JY. Fragmented care and chronic illness patient outcomes: A systematic review. Nurs Open 2023; 10:3460-3473. [PMID: 36622952 PMCID: PMC10170908 DOI: 10.1002/nop2.1607] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
AIM This systematic review examined recent studies on fragmented care of patients with chronic illnesses in the United States to examine the association between fragmented care and patient outcomes. DESIGN Systematic review. METHODS Studies published from January 1, 2012, to June 1, 2022, were selected from four electronic databases (PubMed, CINAHL, PsycINFO, and Web of Science), following the Cochrane protocols and PRISMA statements. Based on inclusion and exclusion criteria, ten studies that examined associations published between 2015 and 2021 were selected. A methodological assessment was conducted with the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The studies selected for this systematic review were rated as having fair methodological rigor. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42021285379). Because of the heterogeneity of the selected studies' data, a systematic narrative synthesis of the extracted data was conducted. RESULTS Three common measures for fragmented care and outcomes were synthesized. A synthesis of the studies found significant association between fragmented care and adverse outcomes of chronic illnesses (emergency department visits, utilization of diagnostic tests, and healthcare costs). Despite the heterogeneity of significant findings between fragmented care and patient outcomes, the relationship between these outcomes and fragmented care was significant. This systematic review provides clear evidence of the association between care fragmentation and its adverse effects on individuals with chronic illnesses. However, mixed relationship findings were also reported. CONCLUSION Given the demands of overcoming fragmented care in healthcare settings in the United States, nurse managers, healthcare leaders, and policymakers should utilize this evidence to reduce fragmented care strategies. It is recommended that nurse researchers and other healthcare practitioners conduct further studies to understand the contexts and mechanisms of fragmented care and develop theoretical frameworks for care fragmentation and chronic illness outcomes.
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Affiliation(s)
- Jee Young Joo
- College of Nursing, Gachon University, Incheon, South Korea
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15
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Saragih ID, Saragih IS, Tarihoran DETAU, Sharma S, Chou FH. A meta-analysis of studies of the effects of case management intervention for stroke survivors across three countries. J Nurs Scholarsh 2023; 55:345-355. [PMID: 36310396 DOI: 10.1111/jnu.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE A stroke survivor who is discharged to home care faces many challenges during the transition from the hospital to home, including managing their care at home and engaging in rehabilitation and recovery. Case management was developed to ease the transition from hospital to home and help people with stroke cope with their care management challenges. However, the effects of case management intervention remain inconclusive. Case management was designed to direct care and may represent a novel method for reducing the burden of care. This study was designed to evaluate the effects of case management interventions on mental health outcomes, activities of daily living capacity, physical function, and social function among stroke survivors. DESIGN Systematic review and meta-analysis. METHODS This study included studies examining the impacts of case management interventions for stroke survivors that were published in English and identified by searching eight databases, from database inception to February 20, 2022. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to pool effect sizes using a random-effects model (in Stata 16.0). The revised Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the methodological quality of each study. FINDINGS The inclusion criteria were satisfied by eight studies (including a total of 1119 stroke survivors). Case management had positive effects on mental health (SMD: 0.26; 95% CI: 0.07 to 0.45, p = 0.001) and activities of daily living (SMD: 0.68; 95% CI: 00.37 to 0.99, p < 0.001). However, no significant effects were observed for either physical function or social function. CONCLUSION Case management appears to enhance the mental health and activities of daily living among stroke survivors. CLINICAL RELEVANCE Case management interventions hold promise as efficient, cost-effective, and accessible strategies to positively influence care for stroke survivors. This intervention strategy could be applied to the hospital-to-home transition to guide care among this population.
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Affiliation(s)
| | | | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana Jakarta, Indonesia.,School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sapna Sharma
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fleming MD, Safaeinili N, Knox M, Hernandez E, Esteban EE, Sarkar U, Brewster AL. Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study. BMC Health Serv Res 2022; 22:1585. [PMID: 36572882 PMCID: PMC9791730 DOI: 10.1186/s12913-022-08979-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.
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Affiliation(s)
- Mark D. Fleming
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Nadia Safaeinili
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Margae Knox
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Elizabeth Hernandez
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Emily E. Esteban
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Urmimala Sarkar
- grid.267103.10000 0004 0461 8879Department of Medicine—San Francisco, University of California, San Francisco, California, USA
| | - Amanda L. Brewster
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
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17
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Lamster IB, Malloy KP, DiMura PM, Cheng B, Wagner VL, Matson JM, Proj A, Xi Y, Abel SN, Alfano MC. Preventive dental care is associated with improved health care outcomes and reduced costs for Medicaid members with diabetes. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.952182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionPreventive dental services have been associated with improved health outcomes. This study expands on previous observations by examining the relationship between oral health care and health care outcomes and costs in a publicly insured population with diabetes.MethodsUtilization of dental services, health care outcomes and costs were evaluated for New York State Medicaid members with a diagnosis of diabetes mellitus (DM), ages 42 to 64, who were continuously enrolled between July 1, 2012 and June 30, 2015. Utilization of dental services focused on preventive dental care (PDC), and extractions and endodontic treatment (both indicative of advanced dental infection). Data were analyzed using regression models with propensity score weighting to control for potential confounding.ResultsReceipt of PDC was associated with lower utilization rates and costs compared to members who did not access dental services. The most pronounced average cost difference was observed for inpatient admissions at $823 per year for members who had at least one PDC without extraction or endodontic treatment. Each additional PDC visit received was associated with an 11% lower rate of inpatient admissions and lower average inpatient costs by $407 per member. The need for a dental extraction or endodontic therapy was associated with relatively higher rates and costs.ConclusionsThese findings demonstrate an association between PDC and improved health care outcome rates and lower average costs among members with DM and suggest a general health benefit associated with provision of preventive dental care for persons with DM.
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Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.
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Care Coordination Models and Tools-Systematic Review and Key Informant Interviews. J Gen Intern Med 2022; 37:1367-1379. [PMID: 34704210 PMCID: PMC9086013 DOI: 10.1007/s11606-021-07158-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Care coordination (CC) interventions involve systematic strategies to address fragmentation and enhance continuity of care. However, it remains unclear whether CC can sufficiently address patient needs and improve outcomes. METHODS We searched MEDLINE, CINAHL, Embase, Cochrane Database of Systematic Reviews, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program, from inception to September 2019. Two individuals reviewed eligibility and rated quality using modified AMSTAR 2. Eligible systematic reviews (SR) examined diverse CC interventions for community-dwelling adults with ambulatory care sensitive conditions and/or at higher risk for acute care. From eligible SR and relevant included primary studies, we abstracted the following: study and intervention characteristics; target population(s); effects on hospitalizations, emergency department (ED) visits, and/or patient experience; setting characteristics; and tools and approaches used. We also conducted semi-structured interviews with individuals who implemented CC interventions. RESULTS Of 2324 unique citations, 16 SR were eligible; 14 examined case management or transitional care interventions; and 2 evaluated intensive primary care models. Two SR highlighted selection for specific risk factors as important for effectiveness; one of these also indicated high intensity (e.g., more patient contacts) and/or multidisciplinary plans were key. Most SR found inconsistent effects on reducing hospitalizations or ED visits; few reported on patient experience. Effective interventions were implemented in multiple settings, including rural community hospitals, academic medical centers (in urban settings), and public hospitals serving largely poor, uninsured populations. Primary studies reported variable approaches to improve patient-provider communication, including health coaching and role-playing. SR, primary studies, and key informant interviews did not identify tools for measuring patient trust or care team integration. Sustainability of CC interventions varied and some were adapted over time. DISCUSSION CC interventions have inconsistent effects on reducing hospitalizations and ED visits. Future work should address how they should be adapted to different healthcare settings and which tools or approaches are most helpful for implementation. TRIAL REGISTRATION PROSPERO #CRD42020156359.
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Gonçalves I, Mendes DA, Caldeira S, Jesus E, Nunes E. Nurse‐led care management models for patients with multimorbidity in hospital settings: a scoping review. J Nurs Manag 2022; 30:1960-1973. [DOI: 10.1111/jonm.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | | | - Sílvia Caldeira
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elvio Jesus
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elisabete Nunes
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
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Gessl AS, Flörl A, Schulc E. Demand for community-based Case Management in Austria - a qualitative analysis. BMC Nurs 2022; 21:5. [PMID: 34983497 PMCID: PMC8725559 DOI: 10.1186/s12912-021-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Alessandra Schirin Gessl
- LMU Munich School of Management, Ludwig-Maximilians-Universität (LMU) München, Geschwister-Scholl-Platz 1, 80539, Munich, Germany
| | - Angela Flörl
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
| | - Eva Schulc
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Caregivers' View of Socio-Medical Care in the Terminal Phase of Amyotrophic Lateral Sclerosis-How Can We Improve Holistic Care in ALS? J Clin Med 2022; 11:jcm11010254. [PMID: 35011995 PMCID: PMC8745628 DOI: 10.3390/jcm11010254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Multidimensional socio-medical care with an early integration of palliative principles is strongly recommended in amyotrophic lateral sclerosis (ALS), but provided inconsistently. We conducted telephone interviews with 49 former caregivers of deceased ALS patients to examine their experience of care in the terminal phase including caregiver burden. Patients who received specialized palliative care (45% of patients) were more likely to die at home (p = 0.004) and without burdening symptoms (p = 0.021). The majority of caregivers (86%) reported deficits in socio-medical care. Most frequently mentioned were problems receiving medical aids (45%) and a lack of caregiver support (35%). A higher level of deficits experienced by caregivers was associated with negative health outcomes on the side of the caregivers (reported by 57% of them; p = 0.002) and stronger caregiver burden (p = 0.004). To provide good quality of dying to patients and reduce the burden on caregivers, multidimensional—including palliative—care in ALS urgently needs to be strengthened in the healthcare structures.
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Kargin M, Aydin A. The experiences of Turkish psychiatric nurses with psychiatric emergencies in the clinics of Turkey's mental health and diseases hospital: A descriptive qualitative study. Perspect Psychiatr Care 2022; 58:39-46. [PMID: 34260750 DOI: 10.1111/ppc.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to describe the experiences of Turkish nurses in the psychiatry clinics of Turkey's Mental Health and Diseases Hospital DESIGN AND METHODS: This descriptive qualitative study was conducted on 20 psychiatric nurses working at a psychiatric hospital. A semi-structured in-person interview technique was used for data collection. RESULTS Six themes were defined in this study. The majority of psychiatric nurses stated that they usually faced suicidal and aggressive cases and that they used security measures, restraint and isolation, medical treatment, and emergency codes as basic interventions. PRACTICE IMPLICATIONS Psychiatry is a field of clinical practice requiring case management skills to deal with various psychiatric presentations.
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Affiliation(s)
- Maral Kargin
- Nursing Department, Faculty of Health Sciences, Cyprus Science University, Kyrenia, Cyprus
| | - Adeviye Aydin
- Nursing Department, Faculty of Health Sciences, Sinop University, Sinop, Turkey
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Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations. PLoS One 2021; 16:e0260928. [PMID: 34879101 PMCID: PMC8654230 DOI: 10.1371/journal.pone.0260928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. Methods Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach. Results and discussion Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders’ engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders’ engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers. Conclusion Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.
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Joo JY, Liu MF. The Experience of Chronic Illness Transitional Care: A Qualitative Systematic Review. Clin Nurs Res 2021; 31:163-173. [PMID: 34727782 DOI: 10.1177/10547738211056166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This is a qualitative systematic review of recent qualitative studies of the experiences and perceptions of both individuals with chronic illness(es) and their caregivers regarding hospital-to-home transitions. Thematic synthesis was used to identify common themes from seven qualitative studies published from 2012 to 2021 and extracted from four electronic databases. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Quality appraisal was assessed and adequate methodological rigor was determined. A total of three barriers to transitional care (communication with multiple healthcare providers, self-management, and psychological stress) and two facilitators of transitional care (family caregiver support and nurse-provided patient-centered care) were identified. These findings can be used by nursing research and healthcare managers to reform transitional care practices for chronic illnesses and caregivers.
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Joo JY, Liu MF. Effectiveness of transitional care interventions for chronic illnesses: A systematic review of reviews. Appl Nurs Res 2021; 61:151485. [PMID: 34544575 DOI: 10.1016/j.apnr.2021.151485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
AIM This systematic review of reviews aims to critically evaluate and synthesize findings from recent systematic reviews to analyze the effectiveness of transitional care interventions in the management of adult patients with chronic illnesses. BACKGROUND Transitional care interventions have been provided to patients with chronic illnesses for reducing fragmented care and hospital readmissions after discharge. However, the effectiveness of the interventions on outcomes other than hospital readmissions is still unclear. REVIEW METHODS This study used the systematic review of systematic reviews methodology. From five electronic databases, systematic reviews published between January 2011 and December 2020 and those that met the inclusion and exclusion criteria were searched and screened to retrieve recent evidence. RESULTS Eight systematic reviews that met the inclusion criteria and had high methodological quality were included. All included transitional care interventions aimed to reduce fragmented care and hospital admissions and improve health care outcomes in chronically ill patients. On summarizing and synthesizing the data, four common outcomes-hospital readmissions, quality of life, mortality, and health care cost savings-were retrieved. There was evidence regarding the effectiveness of transitional care on health care cost savings; however, other outcomes showed mixed results. CONCLUSIONS Transitional care interventions are effective for patients with chronic illnesses. It is important to have standardized outcome measures; therefore, it is recommended to fund research and reimbursement of transitional care practices. The findings and implications of this review are important to nurse managers, health care practitioners, researchers, and policymakers.
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Affiliation(s)
- Jee Young Joo
- Gachon University, College of Nursing, Republic of Korea.
| | - Megan F Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Sathyanarayanan S, Zhou B, Maxey M. Reducing Frequency of Emergency Department and Inpatient Visits Through Focused Case Management. Prof Case Manag 2021; 26:19-26. [PMID: 33214508 DOI: 10.1097/ncm.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY To evaluate whether the Oklahoma State University (OSU) Health Access Network's (HAN's) case management program is effective in reducing the attendance of frequent users to the emergency department (ED) and inpatient department. PRIMARY PRACTICE SETTING This is a 2-year retrospective pre/post-case management analysis. Emergency department usage data from 2013 to 2016 of the OSU HAN contracted clinics are used in this study. This study involves case management interventions for high ED users and high-risk patients. The patients in the study must be enrolled in SoonerCare choice to be case managed. METHODOLOGY AND SAMPLE Patients who visited the ED 3 times or more in 12 months prior to their HAN enrollment and patients with 12 months of data preenrollment and postenrollment were included in the study. A historical control was used to compare ED and inpatient use per patient per month pre- and post-HAN case management. Chi-square and Wilcoxon's signed-rank tests were used to assess the data. RESULTS A total of 29 patients met the inclusion criteria. The number of ED and inpatient visits was reduced after HAN intervention (181 vs. 110, p < .001; 35 vs. 11, p < .001). The ED and inpatient use per patient per month reduced significantly from 0.52 to 0.31 (p < .001) and 0.10 to 0.03 (p < .01), respectively. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE This study suggests that continuous case management and implementation of various care plans with frequent follow-up are effective in reducing the cost of care and subsequent ED and inpatient visits.
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Affiliation(s)
- Shrieraam Sathyanarayanan
- Shrieraam Sathyanarayanan, MS, is a data analyst at the Oklahoma State University Health Access Network (OSU HAN). He manages the OSU HAN database that collects all the care management data. He has expertise in predictive modeling and machine learning
- Biting Zhou, MS, is a current PhD student in the Department of Statistics at the Oklahoma State University Sitllwater. She works on different mathematical models for sampling data
- Matthew Maxey, BSN, MAAL, RN, is the director of the Oklahoma State University (OSU) Health Access Network. He manages all the operations of the program. He designs the key components of the program, such as process improvement and quality assurance projects
| | - Biting Zhou
- Shrieraam Sathyanarayanan, MS, is a data analyst at the Oklahoma State University Health Access Network (OSU HAN). He manages the OSU HAN database that collects all the care management data. He has expertise in predictive modeling and machine learning
- Biting Zhou, MS, is a current PhD student in the Department of Statistics at the Oklahoma State University Sitllwater. She works on different mathematical models for sampling data
- Matthew Maxey, BSN, MAAL, RN, is the director of the Oklahoma State University (OSU) Health Access Network. He manages all the operations of the program. He designs the key components of the program, such as process improvement and quality assurance projects
| | - Matthew Maxey
- Shrieraam Sathyanarayanan, MS, is a data analyst at the Oklahoma State University Health Access Network (OSU HAN). He manages the OSU HAN database that collects all the care management data. He has expertise in predictive modeling and machine learning
- Biting Zhou, MS, is a current PhD student in the Department of Statistics at the Oklahoma State University Sitllwater. She works on different mathematical models for sampling data
- Matthew Maxey, BSN, MAAL, RN, is the director of the Oklahoma State University (OSU) Health Access Network. He manages all the operations of the program. He designs the key components of the program, such as process improvement and quality assurance projects
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Millward K, McGraw C, Aitken LM. The expressed support needs of families of adults who have survived critical illness: A thematic synthesis. Int J Nurs Stud 2021; 122:104048. [PMID: 34392173 DOI: 10.1016/j.ijnurstu.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs. OBJECTIVES This systematic review aimed to provide an in-depth insight into the expressed support needs of families of adults who survived an admission to an intensive care unit and returned to a home environment. It also aimed to explore how these needs change over time, and what support provisions families perceived to be helpful. METHODS This was a systematic review using thematic synthesis methodology. Predefined searches were conducted in CINAHL, Medline, PsychINFO, SocIndex, EMbase, Academic Search Complete, EThOS and OpenGrey to locate studies published in English from 2000. Two reviewers screened each study against the inclusion criteria. Quality appraisal was undertaken using Joanna Briggs Institute tools. Extracted data were managed in Nvivo12® and analysed to identify descriptive and analytical themes. The Timing it Right Framework was used to frame changes in need across the recovery continuum. RESULTS Thirty-nine studies were included, 30 qualitative, eight quantitative and one mixed methods. Five key family needs were identified across the recovery continuum: for security; to make sense of the situation; finding a balance; holding everything together; and for trust. DISCUSSION Families found the following interventions helpful: written information; care coordination and navigation; input from intensive care staff after discharge to support continuity; and provision of family support groups. Although there are similarities between the needs of families and survivors, there are sufficient differences to warrant the development of processes to identify and address family need throughout the recovery continuum. CONCLUSION More research is required to develop a tool to better identify the needs of families across the recovery continuum, identify gaps in current service provision, and design interventions to meet these needs. STUDY REGISTRATION CRD42019136883 (PROSPERO).
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Affiliation(s)
- Kat Millward
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Caroline McGraw
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
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Putra ADM, Sandhi A. Implementation of nursing case management to improve community access to care: A scoping review. BELITUNG NURSING JOURNAL 2021; 7:141-150. [PMID: 37469339 PMCID: PMC10353612 DOI: 10.33546/bnj.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/24/2021] [Accepted: 06/02/2021] [Indexed: 07/21/2023] Open
Abstract
Background Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings. Objectives This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications. Design This study was conducted following the framework of scoping review. Data Sources The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included. Review Methods The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result. Results A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training. Conclusion Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses' advocacy competence for future implications.
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Affiliation(s)
- Alenda Dwiadila Matra Putra
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ayyu Sandhi
- Department of Pediatrics and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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The Checkpoint Program: Collaborative Care to Reduce the Reliance of Frequent Presenters on ED. Int J Integr Care 2021; 21:29. [PMID: 34220393 PMCID: PMC8231479 DOI: 10.5334/ijic.5532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Growing pressures upon Emergency Departments [ED] call for new ways of working with frequent presenters who, although small in number, place extensive demands on services, to say nothing of the costs and consequences for the patients themselves. EDs are often poorly equipped to address the multi-dimensional nature of patient need and the complex circumstances surrounding repeated presentation. Employing a model of intensive short-term community-based case management, the Checkpoint program sought to improve care coordination for this patient group, thereby reducing their reliance on ED. Method: This study employed a single group interrupted time series design, evaluating patient engagement with the program and year-on-year individual differences in the number of ED visits pre and post enrolment. Associated savings were also estimated. Results: Prior to intervention, there were two dominant modes in the ED presentation trends of patients. One group had a steady pattern with ≥7 presentations in each of the last four years. The other group had an increasing trend in presentations, peaking in the 12 months immediately preceding enrolment. Following the intervention, both groups demonstrated two consecutive year-on-year reductions. By the second year, and from an overall peak of 22.5 presentations per patient per annum, there was a 53% reduction in presentations. This yielded approximate savings of $7100 per patient. Discussion: Efforts to improve care coordination, when combined with proactive case management in the community, can impact positively on ED re-presentation rates, provided they are concerted, sufficiently intensive and embed the principles of integration. Conclusion: The Checkpoint program demonstrated sufficient promise to warrant further exploration of its sustainability. However, health services have yet to determine the ideal organisational structures and funding arrangements to support such initiatives.
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Lamster IB, Malloy KP, DiMura PM, Cheng B, Wagner VL, Matson J, Proj A, Xi Y, Abel SN, Alfano MC. Dental Services and Health Outcomes in the New York State Medicaid Program. J Dent Res 2021; 100:928-934. [PMID: 33880960 PMCID: PMC8293758 DOI: 10.1177/00220345211007448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.
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Affiliation(s)
- I B Lamster
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.,Columbia University College of Dental Medicine, New York, NY, USA
| | - K P Malloy
- Bureau of Chronic Disease Evaluation and Research, CSP Data Unit, Office of Public Health, New York State Department of Health (NYSDOH), Albany, NY, USA
| | - P M DiMura
- Bureau of Research and Analysis, Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, New York, NY, USA
| | - B Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - V L Wagner
- Bureau of Research and Analysis, Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, New York, NY, USA
| | - J Matson
- Division of Performance Improvement and Patient Safety, Office of Quality and Patient Safety, NYSDOH, Albany, NY, USA
| | - A Proj
- Bureau of Chronic Disease Evaluation and Research, CSP Data Unit, Office of Public Health, New York State Department of Health (NYSDOH), Albany, NY, USA
| | - Y Xi
- Bureau of Environmental and Occupational Epidemiology, NYSDOH, New York, NY, USA
| | - S N Abel
- Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - M C Alfano
- College of Dentistry, New York University, New York, NY, USA
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Béland S, Dumont-Samson O, Hudon C. Case Management and Telehealth: A Scoping Review. Telemed J E Health 2021; 28:11-23. [PMID: 33847524 DOI: 10.1089/tmj.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Case management (CM) is an intervention adapted to the needs of patients with chronic conditions or complex needs. Factors associated with effectiveness of CM, such as high intervention intensity, can represent challenges to its implementation. Telehealth has the potential to help overcome these challenges, but little work has been done to synthesize available evidence on telehealth CM. The purpose of this scoping review was thus to fill this gap and document which telehealth modalities have been used, summarize perspectives of key users, and discuss evidence on effectiveness of telehealth-delivered CM. Methods: A search in MEDLINE, Scopus, and CINAHL for articles published between January 2005 and January 2021 was done. Studies in which telehealth was used for patient-case manager interaction and conducted in a population with complex health needs and/or chronic conditions were included. Articles selected for full-text review were independently screened by two reviewers. Data extraction was conducted once and validated by a second reviewer. Results: Of 3,108 articles, 22 were retained for data extraction. A narrative synthesis was conducted. Most studies evaluated CM interventions delivered over telephone, yet, literature suggests that face-to-face contact is essential to CM success. Results also indicate that telehealth CM is acceptable and effective, associated with better utilization of health services and favorable clinical outcomes. Conclusions: Lack of research evaluating telehealth CM delivered using modalities other than telephone. Further research should evaluate CM interventions that integrate platforms enabling visual information exchange.
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Affiliation(s)
- Sophie Béland
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Olivier Dumont-Samson
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Canada
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Baughman DJ, Waheed A, Khan MN, Nicholson JM. Enhancing Value-Based Care With a Walk-in Clinic: A Primary Care Provider Intervention to Decrease Low Acuity Emergency Department Overutilization. Cureus 2021; 13:e13284. [PMID: 33728217 PMCID: PMC7955766 DOI: 10.7759/cureus.13284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Emergency department overutilization is a known contributor to the high per-capita healthcare cost in the United States. There is a knowledge gap regarding the substitution effect of walk-in clinic availability in primary care provider (PCP) offices and emergency department utilization (EDU). This study evaluates associations between PCP availability and EDU and analyzes the potential cost savings for health systems. Methods A retrospective cohort analysis compared low acuity EDU rates in established patients at a family medicine residency's PCP office before and after walk-in clinic implementation. The practice had 12 providers, 12 residents, and a patient panel of approximately 7,000-8,000. Inclusion criteria were met if patients were: (1) established with the PCP office, (2) had a low acuity emergency department (ED) visit (emergency index score level 4 or 5) OR had a walk-in clinic visit at the family practice. ED visits were tracked from January 2018 to January 2020 and encounters were compared numbers to pre and post-implementation of a walk-in clinic. Cost savings for comparable management was estimated with average price differences for low acuity encounters in the ED versus clinic. Results Over the two-year timeframe, there were 10,962 total visits to the ED by family practice patients, 4,250 of these visits were low acuity. Despite gross monthly increases of EDU from 2018-2020, after implementation of a walk-in clinic in 2019, rates of total EDU decreased by 1.5% and low acuity utilization rates also decreased. The average annual patient census nearly doubled from 5,763 to 8,042. T-tests confirmed statistical significance with p-values <0.05. Average low acuity ED visits ($437) cost 4.9 times more than comparable PCP office visits ($91). Managing 2,387 patients in the walk-in clinic resulted in an estimated annual cost savings of $825,902. Conclusion Extended walk-in availability in primary care offices provides non-ED capacity for low acuity management and might mitigate low acuity ED utilization while providing more cost-effective care. This study supports similarly described pre-hospital diversions in reducing ED over-utilization by increasing access to care. Higher levels of evidence are needed to establish causality.
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Affiliation(s)
| | - Abdul Waheed
- Family Medicine, Wellspan Good Samaritan Hospital, Lebanon, USA
- Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Muhammad N Khan
- Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, USA
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Doménech-Briz V, Gómez Romero R, de Miguel-Montoya I, Juárez-Vela R, Martínez-Riera JR, Mármol-López MI, Verdeguer-Gómez MV, Sánchez-Rodríguez Á, Gea-Caballero V. Results of Nurse Case Management in Primary Heath Care: Bibliographic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9541. [PMID: 33419267 PMCID: PMC7766905 DOI: 10.3390/ijerph17249541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The new characteristics of today's population, together with the presence of chronic diseases in the elderly, require a new approach to care, promoting coordination between different levels of care. In this sense, we find the figure of the nurse case manager (NCM) in primary health care mainly responsible for ensuring continuity of care in complex patients with chronic diseases. OBJECTIVE to describe the role of the NCM in care management, determining its effectiveness in addressing chronic disease (health outcomes and quality of life) and its efficiency in the health system. METHODS Bibliographic review of scientific evidence on case management applied to nursing. Between March and April 2020 a bibliographic search was carried out in the Dialnet, Scielo, Scopus and Pubmed databases. INCLUSION CRITERIA articles written in the last 5 years, which analyze how this nursing rol influences the care and health of patients. RESULTS A total of 16 articles were selected. The NCM reduced the use of the emergency department, hospital admissions, readmissions, and the duration of these in the patients studied. CONCLUSION The NCM is effective and efficient for both patients and health institutions, and a common practice model is needed that includes standardized protocols and evidence-based practices.
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Affiliation(s)
- Vicente Doménech-Briz
- Hospital Universitario de la Ribera, km 1, Ctra. Corbera, 46600 Alzira, Spain; (V.D.-B.); (Á.S.-R.)
| | - Rosario Gómez Romero
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - Isabel de Miguel-Montoya
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, University of La Rioja, 26006 Logroño, La Rioja, Spain
- Research Group BMP Idi-Paz. Hospital La- Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José Ramón Martínez-Riera
- Departamento Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, E-03080 Alicante, Spain;
| | - María Isabel Mármol-López
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
| | - María Virtudes Verdeguer-Gómez
- Dirección Atención Primaria, Departamento de Salud de Alzira, Alzira, Valencia, Spain. km 1, Ctra. Corbera, 46600 Alzira, Valencia;
| | - Álvaro Sánchez-Rodríguez
- Hospital Universitario de la Ribera, km 1, Ctra. Corbera, 46600 Alzira, Spain; (V.D.-B.); (Á.S.-R.)
| | - Vicente Gea-Caballero
- Nursing School La Fe, adscript center of Universidad de Valencia, 46026 Valencia, Spain; (I.d.M.-M.); (M.I.M.-L.); (V.G.-C.)
- Research Group GREIACC, Health Research Institute La Fe, Avda. Fernando Abril Martorell, 106. Pabellón docente Torre H, Hospital La Fe, 46016 Valencia, Spain
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Health and health service usage outcomes of case management for patients with long-term conditions: a review of reviews. Prim Health Care Res Dev 2020; 21:e26. [PMID: 32744213 PMCID: PMC7443792 DOI: 10.1017/s1463423620000080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: There have been plenty of articles published in recent decades on patient care in the form of case management (CM), but conclusions regarding health outcomes and costs have often been discordant. The objective of this study was to examine previous systematic reviews and meta-analyses with a view to assessing and pooling the overwhelming amount of data available on CM-based health outcomes and resource usage. Methods: We conducted a review of reviews of secondary studies (meta-analyses and systematic reviews) addressing the effectiveness of CM compared with usual care (or other organizational models) in adult (18+) with long-term conditions. PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched from 2000 to the end of December 2017. The outcomes of interest are related to process of care, health measures, and resource usage. Results: Twenty-two articles were ultimately considered: 4 meta-analyses and 18 systematic reviews. There is strong evidence of CM increasing adherence to treatment guidelines and improving patient satisfaction, but none of the secondary studies considered demonstrated any effect on patient survival. Based on the available literature, there is contrasting evidence regarding all the other health outcomes, such as quality of life (QOL), clinical outcomes, and functional status. Good-quality secondary studies consistently found nothing to indicate that CM prompts any reduction in the use of hospital resources. Conclusion: The source of variability in the literature on the consistency of the evidence for most outcomes is unclear. It may stem from the heterogeneity of CM programs in terms of what their intervention entails, the populations targeted, and the tools used to measure the results. That said, there was consistently strong evidence of CM being associated with a greater adherence to treatment guidelines and higher patient satisfaction, but not with a longer survival or better use of hospital resources.
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Abstract
PURPOSE/OBJECTIVES The purpose of this literature review is to evaluate evidence to support advanced education for hospital-based nurse case managers to address the discharge needs of medically complex patients who have extended hospital stays. PRIMARY PRACTICE SETTING Acute care hospital and hospital systems. FINDINGS/CONCLUSION Studies on hospital length of stay are prevalent as are studies of effective case management and the importance of a comprehensive education program. Correlating effective case management to successful disposition of long-stay patients and efficacy of discharge planning education is the focus of this review of evidence. Creation of advanced case management competency education will benefit patients, staff, and the health care system by increasing the skill level to promote early recognition of discharge barriers in complex long-stay patients. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Continued focus on affordability in health care will keep management of hospital length of stay high on the priority list. Pressure to create efficient patient management strategies leading to timely discharge disposition of medically complex patients through barrier mitigation and intervention requires effective case management tools.
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Danish A, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Bisson M, Cassidy M, Condran B, Lambert M, Penney C, Sabourin V, Warren M, Hudon C. Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs. BMJ Open 2020; 10:e038241. [PMID: 32487584 PMCID: PMC7265033 DOI: 10.1136/bmjopen-2020-038241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3). METHODS AND ANALYSIS A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis. ETHICS AND DISSEMINATION This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.
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Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monique Cassidy
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brian Condran
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | | | - Mike Warren
- NL-SPOR Suppport Unit, St-John's, Newfoundland and Labrador, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke Research Centre, Sherbrooke, Québec, Canada
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Byrne A, Hegney D, Harvey C, Baldwin A, Willis E, Heard D, Judd J, Palmer J, Brown J, Heritage B, Thompson S, Ferguson B. Exploring the nurse navigator role: A thematic analysis. J Nurs Manag 2020; 28:814-821. [DOI: 10.1111/jonm.12997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Amy‐Louise Byrne
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Desley Hegney
- Research Division Central Queensland University Brisbane Campus School of NursingBrisbane
| | - Clare Harvey
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Adele Baldwin
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Eileen Willis
- School of Nursing Midwifery and Social Science Central Queensland University Adelaide SA Australia
| | - David Heard
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
| | - Jenni Judd
- School of Health Medical and Applied Sciences Central Queensland University Bundaberg Qld Australia
| | - Janine Palmer
- Hawke’s Bay District Health Board Hastings New Zealand
| | - Janie Brown
- School of Nursing, Midwifery and Paramedicine Curtin University Perth WA Australia
| | - Brody Heritage
- College of Science Health, Engineering and Education Murdoch University Perth WA Australia
| | | | - Bridget Ferguson
- School of Nursing Midwifery and Social Science Central Queensland University Townsville Qld Australia
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How to Reduce Excessive Use of the Health Care Service in Medical Aid Beneficiaries: Effectiveness of Community-Based Case Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072503. [PMID: 32268582 PMCID: PMC7177829 DOI: 10.3390/ijerph17072503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022]
Abstract
Community-based case management for medical aid beneficiaries was implemented in Korea to promote the rational use of medical care and stabilize the financial system. This study investigated the economic impact of community-based case management on reductions in healthcare utilization and costs. This was a program study using a national database to evaluate the effectiveness of community-based case management in changing not only healthcare utilization and costs but also client-centered outcomes using the NHI database and 198 regional databases. A total of 1741 case management clients were included in this study. The case management clients were categorized into three targeted groups and were provided individualized services according to the groups. Client-centered outcomes, such as health-related quality of life (QOL), self-care ability, and having a support system, increased after case management. Healthcare utilization and costs decreased significantly after case management. However, there was no significant difference in the decrease between the groups. An increase in healthcare utilization among medical aid beneficiaries has been observed due to the aging population and an increase in the number of recipients. To reduce healthcare utilization and costs while maintaining the health status of the beneficiaries, it is necessary to expand targeted case management.
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Englert R, Dell’Acqua R, Fitzmaurice S, Yablonsky AM. "We Want to Build a Network": Professional Experiences of Case Managers Working With Military Families. Glob Pediatr Health 2019; 6:2333794X19869784. [PMID: 31497623 PMCID: PMC6716172 DOI: 10.1177/2333794x19869784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 11/15/2022] Open
Abstract
Optimizing case management (CM) services increases service member readiness at
home and abroad. However, little research has been conducted on the experiences
of case managers providing services to military families within the Military
Health System. Semistructured qualitative interviews were conducted to explore
the professional experiences of case managers to identify factors that may
affect care to military families. A total of 53 case managers from military
medical treatment facilities (MTFs) varying in size, location, and branch of
service were interviewed by telephone to explore their perspectives. Qualitative
content analysis was performed. Case managers serve a variety of functions, but
specific roles vary between MTFs. Factors that affect CM services for military
families were identified: (1) need for pediatric specialization, (2) heavy
workload, (3) appropriate staff, (4) patient handoffs, and (5) the role of CM.
Recommendations for improving CM services to facilitate the well-being of
military families are discussed.
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Affiliation(s)
- Robyn Englert
- Naval Health Research Center, San Diego,
CA, USA
- Leidos, San Diego, CA
- Robyn Englert, Naval Health Research Center,
140 Sylvester Rd., San Diego, CA 921106, USA.
| | - Renee Dell’Acqua
- Naval Health Research Center, San Diego,
CA, USA
- Leidos, San Diego, CA
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Hudon C, Chouinard MC, Pluye P, El Sherif R, Bush PL, Rihoux B, Poitras ME, Lambert M, Zomahoun HTV, Légaré F. Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review. Ann Fam Med 2019; 17:448-458. [PMID: 31501208 PMCID: PMC7032902 DOI: 10.1370/afm.2419] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1)population: adult frequent users with chronic disease, (2)intervention: CM in a primary care setting with a postintervention evaluation, and (3)primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec, Canada
| | | | - Pierre Pluye
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Reem El Sherif
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Paula Louise Bush
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Benoît Rihoux
- Institut de Sciences Politiques Louvain-Europe (ISPOLE), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie-Eve Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | | | - France Légaré
- Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Canada
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Exploring the Healthcare Seeking Behavior of Medical Aid Beneficiaries Who Overutilize Healthcare Services: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142485. [PMID: 31336847 PMCID: PMC6678241 DOI: 10.3390/ijerph16142485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
Abstract
We explored the healthcare seeking behavior of Medical Aid (MA) beneficiaries who over-utilize healthcare services in South Korea. We employed a qualitative descriptive study using semi-structured interviews with fifteen community-dwelling MA beneficiaries—who were categorized as over-utilizing healthcare services—and conventional content analysis. Four categories emerged: having unmet healthcare needs, wandering in search of effective healthcare services, routinizing their use of healthcare services, and being concerned about benefit restrictions due to their healthcare overutilization. Overall, these categories indicate participants’ behaviors used to fill the gap between their high healthcare needs and restricted MA benefits. The findings provide a foundation for healthcare providers, policymakers, researchers, and MA beneficiaries to discuss how to better address beneficiaries’ healthcare needs while preventing healthcare overutilization patterns. Effective and innovative interventions that target MA beneficiaries and their case managers are necessary to improve beneficiaries’ quality of life.
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The Impact of Case Management on Reducing Readmission for Patients Diagnosed With Heart Failure and Diabetes. Prof Case Manag 2019; 24:177-193. [DOI: 10.1097/ncm.0000000000000359] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019; 14:e0218903. [PMID: 31233569 PMCID: PMC6590814 DOI: 10.1371/journal.pone.0218903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. METHODS This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. RESULTS Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period. CONCLUSIONS Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.
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Affiliation(s)
| | | | | | | | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Illes Balears, Palma, Spain
| | - Carmen Ortego-Mate
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Group, Santander, Spain
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Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis. PLoS One 2019. [DOI: https://doi.org/10.1371/journal.pone.0218903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bazargan M, Smith JL, Cobb S, Barkley L, Wisseh C, Ngula E, Thomas RJ, Assari S. Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071175. [PMID: 30986915 PMCID: PMC6479964 DOI: 10.3390/ijerph16071175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - James L Smith
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University, Los Angeles, CA 90004, USA.
| | - Emma Ngula
- Department of public health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Ricky J Thomas
- Department of Emergency Medicine, UC Davis Medical Center, University of California, Davis, Sacramento, CA 95817, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
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Joo JY, Huber DL. Case Management Effectiveness on Health Care Utilization Outcomes: A Systematic Review of Reviews. West J Nurs Res 2019; 41:111-133. [PMID: 29542405 DOI: 10.1177/0193945918762135] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Case management is a cost-effective strategy for coordinating chronic illness care. However, research showing how case management affects health care is mixed. This study systematically synthesizes and critically evaluates evidence in systematic reviews of health care utilization outcomes from case management interventions for the care of chronic illnesses. Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions. There was evidence that these interventions positively reduced health care utilization; however, results were mixed. These results and the implications of this review of reviews may be valuable for clinical practitioners, health care researchers, and policymakers.
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