The Impact of a Fmaily-Centered Case Management Approach

Up to 10% of asthmatics have “difficult asthma”; however, they account for 80% of asthma-related expenditure and run the highest risk of acute severe exacerbations. An estimated 75% of admissions for asthma are avoidable. Guidelines advise that these patients be managed by an experienced specialist multidisciplinary team (MDT). We aimed to assess the impact of a case management strategy delivered via specialist MDTs on acute healthcare utilisation of patients with frequent asthma admissions.An MDT (consultant, specialist nurse, physiotherapist and psychologist) case management strategy was introduced in 2010 at University Hospital Southampton Foundation Trust (Southampton, UK) to support patients with frequent asthma admissions during admission and then in clinic. To assess efficacy, we systematically searched the hospital database for patients acutely admitted for asthma on two or more occasions in 2010, 2011 and 2012. Data were collected retrospectively covering patient demographics, admission details, asthma severity and comorbidity.From 2010 to 2012, 84 patients were admitted on two or more occasions per year (80% female, mean body mass index 31 kg·m−2 and 55% psychological comorbidity). After introducing an MDT approach repeat asthma admissions fell by 33% from 127 in 2010 to 84 in 2012 (p=0.0004). In addition, bed days fell by 52% from 895 in 2010 to 430 in 2010 (p=0.015).An MDT case management approach significantly reduces hospitalisation in difficult asthma patients with prior frequent admission.

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TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

Endoscopy International Open ◽

10.1055/a-1326-1533 ◽

2021 ◽

Vol 09 (03) ◽

pp. E348-E355

Author(s):

David L. Diehl ◽

Harshit S. Khara ◽

Nasir Akhtar ◽

Rebecca J. Critchley-Thorne

Keyword(s):

High Risk ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Clinical Decision Making ◽

Eradication Therapy ◽

Low Risk ◽

Management Approach ◽

Low Grade ◽

Management Decisions ◽

The Impact

Abstract Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

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Type A aortic dissection: involvement of carotid artery and impact on cerebral malperfusion

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320984329 ◽

2020 ◽

pp. 021849232098432

Author(s):

Wahaj Munir ◽

Jun Heng Chong ◽

Amer Harky ◽

Mohamad Bashir ◽

Benjamin Adams

Keyword(s):

Carotid Artery ◽

Aortic Dissection ◽

Type A ◽

Current Evidence ◽

Management Approach ◽

Complex Nature ◽

Acute Type ◽

Type A Aortic Dissection ◽

Cerebral Malperfusion ◽

The Impact

Acute type A aortic dissection is a surgical emergency and management of such pathology can be complex with poor outcomes when there is organ malperfusion. Carotid artery involvement is present in 30% of patients diagnosed with acute type A aortic dissection, and given its emergency and complex nature, there is much controversy regarding the approach, extent of treatment, and timing of the intervention. It is clear that the occurrence of cerebral malperfusion adds an extra layer of complexity to the decision-making framework for treatment. Standardization and validation of the optimal management approach is required, and this should ideally be addressed with large-scale studies. Nonetheless, current literature supports the need for rapid recognition and diagnosis of acute type A aortic dissection with cerebral malperfusion, immediate and extensive surgical repair, and the appropriate use of cerebral perfusion techniques. This paper aims to discuss the current evidence regarding the impact of carotid artery involvement in both the management and outcomes of acute type A aortic dissection.

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Evaluating the Impact of Intensive Case Management for Severe Vocational Injuries on Work Incapacity and Costs

Journal of Occupational Rehabilitation ◽

10.1007/s10926-021-09967-6 ◽

2021 ◽

Author(s):

Rolando Leiva ◽

Lise Rochaix ◽

Noémie Kiefer ◽

Jean-Claude K. Dupont

Keyword(s):

Treatment Group ◽

Case Management ◽

Sick Leave ◽

Insurance Fund ◽

Large Set ◽

Intensive Case Management ◽

Exact Matching ◽

Case Management Program ◽

The Impact ◽

Permanent Work

AbstractPurpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

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Capitation Financing for the Chronic Mentally Ill: A Case Management Approach

Psychiatric Services ◽

10.1176/ps.39.1.68 ◽

1988 ◽

Vol 39 (1) ◽

pp. 68-72 ◽

Cited By ~ 1

Author(s):

Maxine Harris ◽

Helen C. Bergman

Keyword(s):

Case Management ◽

Mentally Ill ◽

Management Approach

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Models of home care services for persons with dementia: a narrative review

International Psychogeriatrics ◽

10.1017/s1041610215000137 ◽

2015 ◽

Vol 27 (10) ◽

pp. 1593-1600 ◽

Cited By ~ 14

Author(s):

Lee-Fay Low ◽

Jennifer Fletcher

Keyword(s):

Case Management ◽

Home Care ◽

Integrated Care ◽

Community Dwelling ◽

Narrative Review ◽

Nursing Home Admission ◽

Community Based ◽

People With Dementia ◽

The Impact ◽

Community Based Services

ABSTRACTBackground:Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care.Methods:We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs.Results:Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study.Conclusions:There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

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Assessing the evidence on case management

The British Journal of Psychiatry ◽

10.1192/bjp.181.1.17 ◽

2002 ◽

Vol 181 (1) ◽

pp. 17-21 ◽

Cited By ~ 22

Author(s):

S. J. Ziguras ◽

G. W. Stuart ◽

A. C. Jackson

Keyword(s):

Mental Health ◽

Case Management ◽

Statistical Power ◽

Cochrane Collaboration ◽

Randomised Trials ◽

Inclusion Criteria ◽

Management Effectiveness ◽

Trade Off ◽

The Cochrane Collaboration ◽

The Impact

BackgroundEvidence on the impact of case management is contradictory.AimsTo discuss two different systematic reviews (one conducted by the authors and one conducted through the Cochrane collaboration) that came to contradictory conclusions about the impact of case management in mental health services.MethodWe summarised the findings of the two reviews with respect to case management effectiveness, examined key methodological differences between the two approaches and discuss the impact of these on the validity of the results.ResultsThe differences in conclusions between the two reviews result from the differences in inclusion criteria, namely non-randomised trials, data from unpublished scales and data from variables with skewed distributions. The theoretical and empirical effects of these are discussed.ConclusionsSystematic reviewers may face a trade-off between the application of strict criteria for the inclusion of studies and the amount of data available for analysis and hence statistical power. The available research suggests that case management is generally effective.

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An Emerging Methodology of Slope Hazard Assessment for Natural Gas Pipelines

Volume 1: Codes, Standards and Regulations; Design and Constructions; Environmental; GIS/Database Development; Innovative Projects and Emerging Issues ◽

10.1115/ipc2000-159 ◽

2000 ◽

Author(s):

Z. Joe Zhou ◽

Bill Liu ◽

Gregg O’Neil ◽

Moness Rizkalla

Keyword(s):

Natural Gas ◽

Public Information ◽

Ground Movement ◽

Management Approach ◽

Hazard Management ◽

Slope Movements ◽

Natural Gas Pipelines ◽

Site Investigations ◽

The Impact ◽

Ranked List

TransCanada Pipelines Ltd. (TransCanada) operates approximately 37,000 km of natural gas gathering and transmission pipelines. Within the Alberta portion of this system there are almost 1100 locations where the pipeline(s) traverse slopes, primarily as the line approaches and exits stream crossings. In the past, the approach to managing the impact of slope movements on pipeline integrity has been reactive; site investigations and/or monitoring programs would only be initiated once the slope movements were sufficiently large so as to easily observe cracking or scarp development. In some cases these movements could lead to a pipeline rupture. To move to a proactive hazard management approach and to optimize the maintenance expenditure, TransCanada has developed a new slope assessment methodology. The objective of this methodology is to establish a risk-ranked list of slopes upon which maintenance decisions can be based. Using only internal and public information on site conditions as input to predictive models for rainfall-ground movement and pipe-soil interaction, a probability of pipeline failure can be generated for each slope. Estimates of risk using a consequence-matrix approach enabled the compilation of a risk-ranked list of hazardous slopes. This paper describes this methodology, and its implementation at TransCanada, and presents some of the results.

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