Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis

Abstract

Introduction: Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. Methods:A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada).Results: Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use. Conclusion and discussion:This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.

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

“…In line with North American guidelines [ 10 , 11 ] and findings of prior studies [ 12 , 14 , 29 – 31 ], including some authored by members of this study team [ 32 , 33 ], the CMI consisted of four main components: 1) assessment of patient needs and preferences; 2) co-development and maintenance of a patient-centred individualized service plan, i.e. a plan co-created with the patient, family and other partners to coordinate all the services required to meet the patient’s life plan (goals and desired outcomes); 3) coordination of services among all partners; and 4) education and self-management support for patients and families.…”

Delivering Integrated Community Care for the Elderly: A Qualitative Case Study in Southern China

“…In the practice of integrated care, the Case Management Programs (CMP) strategy is employed to address the needs of frequent users of healthcare services with complex requirements [ 36 ]. A doctor or physiatrist, alongside a nurse, is designated as the case manager to assess, plan, implement, coordinate, and prioritize services according to individual needs, social workers, and informal caregivers [ 37 ]. To enhance coordination further, the HS CHC has established social work stations under the Elderly Care Department (the yi-yang-jie-he unit).…”

Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care

“…The number of barriers to outpatient care was logged for each patient (0, 1-2, 3+). The variable "having a case manager" was also measured as it plays a key role in responding to patients with complex needs and helping them navigate the health and social services system [31]. Having a case manager has been proven to help patients reduce acute care [32][33][34].…”