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PubMed2006

Role of the HIV/AIDS case manager: analysis of a case management adherence training and coordination program in North Carolina.

Highly active antiretroviral therapy (HAART) adherence rates of 90%-95% or more are required to be effective at treating the virus and preventing drug resistance. From both a medical and public health perspective, it is essential that HIV-positive clients strictly adhere to antiretroviral treatment regimens. One promising approach to promoting optimal adherence rates among HIV-positive individuals is training and reimbursing case managers to provide adherence coordination services to HIV-positive clients. In this study, a sample of 16 HIV/ AIDS case managers from agencies across North Carolina participated in a Case Management Adherence Training and Coordination Program for a 3-month period. After case manager training, case managers enrolled 1-4 of their existing clients, who met eligibility criteria, to receive the adherence coordination program. Data were analyzed from focus group interviews and individual interviews conducted with case manager participants; their respective client care plans were also analyzed to identify primary barriers and strategies reported by case managers. Although case managers perceived themselves to be well positioned to provide adherence coordination services for their HIV-positive clients, they also identified barriers that they face in providing these services, including lack of reimbursement for their time, inadequate training, and insufficient knowledge of HIV/AIDS and medications. The findings of this study suggest that, with appropriate training and reimbursement, HIV/AIDS case managers can play a pivotal role in promoting and improving client adherence to antiretroviral medications.

Antiretroviral Therapy, Highly Active↗
PubMed1997

Medicaid, Medicare, and managed care. Case management for dually eligible clients.

A dually eligible person is one who qualifies for both Medicaid and Medicare benefits. When elderly persons need acute care services, they enter a different part of the service delivery system where Medicare is the major payer. Typically, this part of the system is disconnected from the long-term care portion. Rather than working together for the maximum benefit of consumers, each part of the system is motivated to guard its resources jealously. Integration of Medicare and Medicaid offers states the opportunity to demonstrate how better care can be provided by using resources more effectively. However, managed care may bring changes in care delivery and new payers for services which may affect the role of case managers.

Case Management↗
PubMed2006

Approaches to child protection case management for cases involving people with disabilities.

OBJECTIVES: This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. METHOD: Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. RESULTS: Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. CONCLUSION: While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.

Case Management↗
PubMedDate not supplied

Global case management: impact of case management on client outcomes.

This study applied a descriptive design to determine the usefulness of nursing diagnoses, on the basis of the Omaha System framework, in explaining utilization of primary health care services. Important findings include the identification of a medium number of problems for each client (M = 3.2), the broad range of problems, and an associated narrow number of interventions (M = 2.4 per client). The most frequently identified problems by domain were psychological (35.7%). Interventions were provided most frequently for diagnoses in the physiological domain with health teaching, guidance, and counselling of intervention category. The results of this study suggest that data related to nursing diagnoses are a valuable source of information when examining home health care nursing resource use.

Adult↗
PubMed1990

An investigation of managed health care case managers.

Managed care case management is a relatively new concept within health and rehabilitation. As such, it lacks both definition and profiles of those providing services. This paper constructs a definition of managed care case management and presents the detailed results of a survey that identified the characteristics of case managers in the Midwest. The survey was mailed to 250 subjects. The respondents of the survey (N = 56) were relatively young (the largest number of respondents were 30 to 39 years of age), relatively new to their jobs (means = 2.2 years), and were typically employed full-time. They primarily served mental health (n = 43) and physically impaired (n = 30) clients. The highest number of their service referrals were made to vocational rehabilitation specialists, social workers, occupational therapists, nurses, and physical therapists.

Administrative Personnel↗
PubMedDate not supplied

Case managers' roles and functions: Commission for Case Manager Certification's 2004 Research, Part I.

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004. The purpose of this research was to validate the currency and relevancy of the certified case manager examination. The results of this study are shared in 2 parts of an article. Part I discusses the process the CCMC used for the development of the Case Manager's Role and Functions Survey Instrument (CMRFSI). The research leads to the identification of 6 new essential functions and 6 new knowledge areas, which describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the survey results and focuses on identifying the empirical activity and knowledge domains of case management practice, using factor analysis. It also discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, it summarizes future changes in the field of case management as perceived by those who participated in the study.

Adult↗
PubMedDate not supplied

Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, part II.

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004 for the purpose of validating the currency and relevancy of the certified case manager examination. The results of this study are shared in an article of 2 parts. Part I, which was published in the previous issue of this journal, discussed the process the CCMC used for the development of the Case Managers' Role and Functions Survey Instrument and the identification of new 6 essential functions and 6 knowledge areas that describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the results and focuses on identifying the empirical (statistically derived) activity and knowledge domains of case management practice, using exploratory factor analysis. It discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, Part II summarizes future changes in the field of case management as perceived by those who participated in the study.

Adult↗
PubMed2003

A critical analysis of the broker and strengths models of case management: identifying a potential framework for community case managers.

In Canada, case management has been applied to a variety of health care settings including the community care system, where case managers have become an integral component in the delivery of government-funded, in-home services. Specifically in Ontario, home care is accessed through 43 Community Care Access Centres (CCACs), and the model currently driving case management practices most closely resembles the Broker model. Not only does this create moral distress among the case managers, but it also hinders their ability to meet the health care needs of the community as current cost containment strategies can lead to suffering and emotional distress for a significant portion of the people who are cut from care. This article will identify a potential framework for case managers in CCACs. The Strengths model offers a framework that is consistent with the goals of Ontario case managers and is committed to client autonomy, empowerment, and client-driven care. Given the multitude of health care challenges facing CCAC case managers today, the Strengths model of practice has the potential to contain and maintain costs without compromising the psychological wellbeing and health care needs of the community.

Caregivers↗
PubMed2005

Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development.

AIMS: Description of nurse case management experiences across different settings and patient populations is needed to define critical elements of the intervention and to help develop a workforce capable of responding to the growing diabetic population. METHODS: In a clinic providing services to American Indian and Alaska Native people, a retrospective cohort design was used to assess outcomes of patients who did and did not receive case management services and to quantify the case load of a team of four nurse case managers. RESULTS: Patients with nurse case managers were more likely to have an eye examination [OR 2.9, 95% CI (2.1, 3.8)], diet and exercise instruction by a registered dietitian [OR 2.8, 95% CI (1.9, 4.1)], self monitor blood glucose [OR 2.1, 95% CI (1.5, 3.1)], dental examination [OR 1.7, 95% CI (1.3, 2.3)], foot examination [OR 1.6, 95% CI (1.2, 2.1)], and nephropathy screening [OR 1.6, 95% CI (1.2, 2.1)]. After adjustment for type of treatment, initial HbA(1c), and diet instruction by a registered dietitian, the change in HbA(1c) remained significantly greater among those patients with a case manager than in those without (-0.52 units with vs. -0.17 units without, P < 0.006). The case load used to achieve this outcome averaged one nurse case manager per 365 patients. CONCLUSIONS: In this setting, a case management team comprised of four nurses with varying degrees of clinical experience was effective in improving adherence with diabetes services and had a favourable effect on short-term glucose control trends.

Adult↗
PubMed2006

Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program.

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.

Asthma↗
PubMedDate not supplied

Global case management: Hong Kong. Care for the hospital-discharged frail elders by nurse case managers: a process evaluation of a longitudinal case management service project.

Using quantitative and qualitative methodology, a study was conducted on the process of case management performed by nurse case managers on a group of 45 post-discharged frail elderly patients in 2001-2002. The quantitative data provided the common reasons for client-initiated telephone calls to nurse case managers and the nurse case managers' interventions to these calls. Qualitative data yielded 9 major themes on which a sequential and dynamic process model of case management was conceptualized. Another 7 thematic descriptions on essential factors for the successful implementation of case management were configured in a dual-dimensional framework of staff and structural factors.

Aftercare↗
PubMed2000

What do case managers do? An investigation of case manager interventions and their relationship to client outcome.

BACKGROUND: The aim of the present study, which forms part of a wider case management multicenter study, was to explore the content of case managers' work, service patterns, and their relationship to client outcome. METHODS: Client background characteristics were registered at admission, and needs of care and psychosocial functioning were assessed at admission to the service and after 18 months. In seven of the services an extended follow-up was performed, which included assessments regarding quality of life, level of symptoms and social network. The study comprised 176 severely mentally ill clients, of whom 153 participated in a general 18-month follow-up (87%), with 113 clients out of 134 participating in an extended follow-up sample (84%). RESULTS: The investigation of service patterns showed that clients received services in a great variety of life areas using a number of different types of interventions. The results support the assumption that severely mentally ill clients are in need of case management services that offer more than brokerage services and coordination. A more active rehabilitation-oriented approach was found towards younger clients and clients who had a job, which may reflect a higher level of ambition in assisting younger clients to gain access to and stay in education and the labor market. Several types of intervention were related to client outcome. Brokerage, intervention planning and more interventions in the area of skills relating to activities of daily living were related to a more pronounced decrease in needs of care. More time spent on indirect work on behalf of the clients was related to a better outcome with regard to psychiatric symptoms and social network. CONCLUSIONS: The results indicate that specific service components have a more obvious distinct impact than others on outcome, and that this increase in effectiveness varies with the outcome targeted.

Adult↗