Case management, care management and care programming

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.

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Practical and measurable definitions of care coordination, care management, and case management

Translational Behavioral Medicine ◽

10.1093/tbm/ibaa001 ◽

2020 ◽

Vol 10 (3) ◽

pp. 664-666 ◽

Cited By ~ 1

Author(s):

Mark D Williams

Keyword(s):

Case Management ◽

Care Coordination ◽

Chronic Conditions ◽

Identifying Potential Care Management Candidates: The Use of Diagnosis-Based Models to Predict 5-Year Health Care Costs

Care Management Journals ◽

10.1891/1521-0987.17.2.105 ◽

2016 ◽

Vol 17 (2) ◽

pp. 105-111

Author(s):

John Robst

Keyword(s):

Health Care ◽

Case Management ◽

Regression Models ◽

Care Management ◽

Predictive Power ◽

Service Use ◽

Claims Data ◽

Individual Characteristics ◽

Estimation And Prediction ◽

Care Costs

Objective: This article examined individual characteristics associated with having higher costs in a 5-year period to identify patients that may potentially benefit from case management.Methods: Florida Medicaid claims data from 2005 to 2010 were used to examine the characteristics, diagnoses, and services (in 2005) associated with individual costs in 5 future years (2006–2010). The data were divided into estimation and prediction samples with regression models estimated using diagnoses and service use in 2005 to predict future costs. Predictive power was assessed by applying the model results to the prediction sample and comparing predicted costs to actual costs.Results: Demographics, service use, and diagnosis in 2005 were associated with costs in the following 5 years. Models were predictive of future costs with a significant relationship between the predicted costs and actual costs.Conclusion: Diagnosis-based models in conjunction with prior costs can predict future costs. Individuals predicted to have higher costs may be candidates for case management to potentially avoid reduce costs.

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Design and Application of a Theory-Based Case/Care Management Model for Home Care: Advanced Practice for Nurses as Care Managers

Care Management Journals ◽

10.1891/cmaj.3.4.166.57450 ◽

2002 ◽

Vol 3 (4) ◽

pp. 166-171 ◽

Cited By ~ 2

Author(s):

Nancy A. Sears

Keyword(s):

Case Management ◽

Home Care ◽

Care Management ◽

Management Practice ◽

Process Research ◽

Management Model ◽

Advanced Practice ◽

Management Research ◽

Design And Implementation ◽

Practice Care

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

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Automatic Knowledge Discovery and Case Management: an Effective Way to Use Databases to Enhance Health Care Management

IFIP Advances in Information and Communication Technology - Artificial Intelligence Applications and Innovations III ◽

10.1007/978-1-4419-0221-4_29 ◽

2009 ◽

pp. 241-247

Author(s):

Luciana SG Kobus ◽

Fabrício Enembreck ◽

Edson Emílio Scalabrin ◽

Joãoda da Silva Dias ◽

Sandra Honorato da Silva

Keyword(s):

Health Care ◽

Case Management ◽

Knowledge Discovery ◽

Care Management ◽

Health Care Management

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The impact of very early referral on the effectiveness of specialty cancer care management services for oncology patients in active treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.157 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 157-157

Author(s):

Eric J. Gratias ◽

Melissa Lindholm ◽

Arthur H. Rossof ◽

Richard B. Weininger ◽

Margaret Rausa ◽

...

Keyword(s):

Case Management ◽

Active Treatment ◽

Cancer Care ◽

Care Management ◽

Management Program ◽

Cancer Case ◽

High Morbidity ◽

Oncology Patients ◽

Early Referral ◽

The Impact

157 Background: Many patients receiving treatment for cancer experience high levels of morbidity and reduction in quality of life. Proactive specialty cancer care management programs can be offered to patients experiencing these challenges. These patients are most often self-identified, referred by a physician, or identified by claims from a commercial or government insurer or vendor. While earlier intervention of case management or palliative care services has been shown to improve outcomes for cancer patients, a variety of logistic challenges frequently interfere with early referral. Methods: All oncology patients obtaining regimen-based chemotherapy prior authorizations were referred for specialty cancer care management via the prior authorization process. Additionally, all oncology patients in active treatment or with active disease whose benefits included care management were eligible through standard referral mechanisms. Patient satisfaction scores were measured every 3 months for all patients enrolled in the program. The medical cost savings value of referral to the specialty cancer care management program was evaluated by comparing patients referred to the program within 30 days of diagnosis (very early referrals) against patients found between 30 and 120 days from the time of diagnosis. Results: Compared with patients referred through standard methods, patients referred to the specialty cancer care management team at the time of chemotherapy authorization resulted in a high percentage of very early referrals. Patients enrolled in specialty cancer case management within 30 days of diagnosis saved an average of $16,000 per surviving participant, or 30% more than patients referred between 30 and 120 days from diagnosis. Overall, patients engaged in specialty cancer case management are highly satisfied. Overall satisfaction with the nurse/case manager was 98%. Conclusions: Early referral of high risk oncology patients to patient-centered care management programs improves the overall patient experience while simultaneously reducing health care costs, and should be strongly considered for all oncology patients with high morbidity or mortality risk.

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Emergent Approaches to Care Coordination in England: Exploring the Evidence From Two National Organizations

Care Management Journals ◽

10.1891/1521-0987.12.4.194 ◽

2011 ◽

Vol 12 (4) ◽

pp. 174-181 ◽

Cited By ~ 4

Author(s):

Jane Hughes ◽

Siobhan Reilly ◽

Kathryn Berzins ◽

Jessica Abell ◽

Karen Stewart ◽

...

Keyword(s):

Primary Care ◽

Case Management ◽

Older People ◽

Care Coordination ◽

Care Management ◽

Implementation Process ◽

Service Characteristics ◽

Care Services ◽

Health And Social Care ◽

National Organizations

For many years, there has been an international concern about the fragmented nature of health and social care services for vulnerable older people and younger adults. This article examines the implementation of two major policies in England designed to ensure frail adults and older people receive services appropriate to their needs. First, care management, which was introduced in 1993 and provided by local government, and second, case management, which was introduced in 2005 and provided by primary care through the National Health Service. An analysis of the implementation of the two policies is presented, and data from two national surveys are used to describe similarities and differences between the two approaches in terms of goals, arrangements, service characteristics, and indicators of integration and differentiation within care coordination arrangements. Both were designed to promote the provision of care at home as an alternative to more costly alternatives. Discretion within the policy implementation process has militated against the development of a more differentiated approach to care management in local authorities as compared with case management in primary care trusts and more generally, integration between the two. Future developments within both service settings will be influenced by the introduction of personal budgets.

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