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PubMed2000

Cephalic version by postural management for breech presentation.

BACKGROUND: It is possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version. OBJECTIVES: The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth trials register and Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by both reviewers. MAIN RESULTS: Three studies involving a total of 192 women were included. Postural management was associated with a non-significant trend towards fewer non-cephalic births (relative risk 0.90, 95% confidence interval 0. 73 to 1.12). No differences were detected for caesarean sections or Apgar scores below seven at one minute. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of postural management for breech presentation.

Breech Presentation↗

PubMed2000

Improving health professionals' management and the organisation of care for overweight and obese people.

BACKGROUND: Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services. Health professionals have a key role to play in tackling the obesity problem, but little is known about how they may be encouraged to work more effectively with overweight and obese people. OBJECTIVES: The main objective was to determine whether health professionals' management or the organisation of care for overweight and obese people could be improved. SEARCH STRATEGY: We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (May 1997), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to January 1998, EMBASE to December 1997, Cinahl (1982 to November 1997), PsycLit (1974 to December 1997), Sigle (1980 to November 1997), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field. SELECTION CRITERIA: Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twelve studies were included involving more than 393 providers and 3392 patients. Four studies were identified for comparison 1. Three were professional-oriented interventions (the use of reminders and training) and the fourth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Eight studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality. REVIEWER'S CONCLUSIONS: At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.

Body Weight↗

PubMed1993

Management of severe, early pre-eclampsia: is conservative management justified?

A retrospective analysis was performed to assess the fetal and maternal benefits of allowing women presenting with severe pre-eclampsia between 24 and 32 weeks to continue their pregnancy following treatment of their hypertension. Cases presenting in Oxford (conservative management) and in Birmingham (stabilisation and early intervention) were compared. Patients were considered to require treatment when their systolic blood pressure was > or = 170 mmHg systolic or > or = 110 mmHg diastolic, associated with at least 1+ proteinuria and hyperuricaemia. We compared gestation at delivery, birth weight and neonatal complications for each group, and any maternal morbidity. There were 28 patients in each group. Gestational age at delivery was significantly less in the group managed by early intervention. Those women managed conservatively gained a mean of 9.5 days (range 2-26 days; P < 0.05), and their birthweight was significantly greater (P < 0.05). There was a significant difference between the length of stay in the neonatal intensive care unit between the 2 groups (P < 0.05), the babies of those women managed conservatively staying a mean of 7.4 days less. There were fewer neonatal complications in those cases managed conservatively, the number of newborns with 1 or more complications in the early intervention group being 18 (64.3%), compared with 8 (28.6%) in the expectant management group (P = 0.0001). All of the women in the group managed by early intervention recovered with no severe complications. However, those women managed conservatively had a higher incidence of HELLP (2 cases) and ELLP syndrome (2 cases), 1 case requiring temporary renal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗

PubMed2006

Design principles and common pool resource management: an institutional approach to evaluating community management in semi-arid Tanzania.

This paper analyses the role of institutions in the management of common pool resources (CPRs) in semi-arid Tanzania. Common property regimes have often been considered inadequate for the management of CPRs because of the problems of excludability, but they are becoming more widely supported as the way forward to overcome the problems of resource use and degradation in developing countries. A series of design principles for long enduring common property institutions have been proposed by Ostrom, but there is concern that they are not applicable to a wide range of real life situations or that they may be specific to certain types of CPR. Here, we compare these principles to the situation prevailing in 12 villages in six districts in semi-arid Tanzania. Data on management institutions were collected through semi-structured interviews and meetings at district and village level. The combined information was used to make a qualitative assessment of the strength with which each design principle appeared to operate in the management of forest, pasture and water resources. Boundaries, conflict and negotiation in CPR management are of key importance in semi-arid regions. However, the need for flexibility in order to deal with ecological uncertainty means that many management institutions would be considered weak or absent according to the design principle approach. This supports the view that the design principles should not be used as a 'blueprint to be imposed on resource management regimes' rather that they provide a framework for investigating common property regimes with the proviso that, certainly for semi-arid regions, they may highlight where management cannot be explained by institutional theory alone.

Agriculture↗

PubMed2002

Management of miscarriage: a randomized controlled trial of expectant management versus surgical evacuation.

BACKGROUND: In many countries, surgical uterine evacuation is the standard treatment for women with a miscarriage, but expectant management has been advocated as an alternative. The choice between the two options cannot be based on published evidence alone, because randomized clinical trials are scarce while generalizability of findings to patients with a strong preference for either management options is unclear. METHODS: In a randomized controlled trial, the complications and efficacy of either expectant or surgical management for miscarriages were compared, and the results in patients who refused randomization and were managed according to their own preference were studied. In total, 122 patients were randomized and 305 were managed according to their choice. RESULTS: No differences were found in the number of emergency curettages and complications between expectant and surgical management. Efficacy at 6 weeks was 30/64 (47%) in women allocated to expectant management, and 55/58 (95%) in women allocated to surgical evacuation. After 7 days, 37% of expectantly managed women had a spontaneous complete miscarriage. After 6 weeks, intention-to-treat analysis including cross-overs showed similar effectiveness (92% versus 100%). Results in the preference groups were comparable with those in the randomized groups. CONCLUSION: In our experience a waiting period of 7 days after diagnosis may prevent 37% of surgical procedures.

Abortion, Spontaneous↗

PubMed2006

Complications of nonoperative management of pediatric blunt hepatic injury: Diagnosis, management, and outcomes.

BACKGROUND: Nonoperative management (NOM) of blunt hepatic injury is the standard of care in the hemodynamically stable pediatric patient, but it is not without pitfalls. The purpose of this study is to assess the incidence and types of complications associated with NOM in terms of diagnosis, management, and outcomes. METHODS: A retrospective study of pediatric patients with blunt hepatic injuries admitted from 1991 through 1997 to a Level I pediatric trauma center was conducted. All stable patients were initially managed nonoperatively according to the Isolated Liver Laceration Critical Pathway. Surveillance was performed by physical examination and tracking of hematocrit and liver function test (LFT) results. Follow-up ultrasound (US) or computed tomography (CT) were performed as clinically indicated. RESULTS: In all, 185 patients with nonoperatively managed blunt hepatic injuries were identified during a 7-year period. Over 90% (168/185) were successfully managed nonoperatively without adverse sequelae. Ten patients (5.4%) died: seven as a result of head injury; three as a result of multisystem organ failure; none directly attributable to their hepatic injuries. Complications occurred in seven patients (3.8%) with Grades III or IV right lobe liver lacerations and included biloma (5), hepatic artery pseudoaneurysm with hemobilia (1), and necrotic gallbladder (1). All seven patients (100%) had fever, persistent or worsening right upper quadrant pain, feeding intolerance, and persistently elevated LFTs. Complications were diagnosed by CT or US. Nonoperative treatment of complications was successful in four of the seven patients (57.1%) and consisted of percutaneous drain placement only (1), percutaneous drain placement and endoscopic retrograde cholangiopancreatography (ERCP)-guided stent placement (2) and angioembolization (1). Three patients (42.9%) required laparotomy, one for management of a concomitant pancreatic pseudocyst. CONCLUSION: Complications of NOM of pediatric blunt hepatic injury are rare, but may include biloma, hepatic artery pseudoaneurysm, and necrotic gallbladder. Complications occur only with Grade III or greater injuries and are accompanied by fever, right upper quadrant pain, feeding intolerance, and persistently elevated LFTs. The clinician must maintain a high index of suspicion for the development of complications and have a low threshold for obtaining a CT or US for diagnosis. Interventional radiology techniques, angiography, and ERCP are useful adjuncts to nonoperative management, but some patients may still require laparotomy for management of complications.

Adolescent↗

PubMed2006

Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness.

BACKGROUND: Patient education self-management programmes draw on sociological understanding of experiencing single chronic illnesses, but health practitioners do not always recognize the tensions and ambiguities permeating individuals' management experiences, particularly for those with multiple morbidity. The aim of this study was to illuminate how people negotiate multiple chronic illness, and everyday life. METHODS: A sample of 23 people in their early 50s was recruited from a community health survey in Scotland. The participants had four or more chronic illnesses and were interviewed twice. The qualitative data that were generated highlighted the impact of illness and associated management strategies, as people attempted to continue familiar lives. Analysis was based on constant comparison and informed by a narrative approach. RESULTS: People used multiple techniques to manage symptoms and conveyed a moral obligation to manage 'well'. However, maintaining valued social roles, coherent identities and a 'normal life' were prioritized, sometimes over symptom containment. This led to tensions, and participants faced moral dilemmas as they self-managed. DISCUSSION: Self-management policies, programmes and healthcare practitioners need to recognize the tensions that people experience as they negotiate symptoms, valued social roles, positive identities, and daily life. Addressing these issues may improve opportunities to support patients in particular contexts, and enhance self-management.

Adaptation, Psychological↗

PubMed2006

Deconstructing adaptive management: criteria for applications to environmental management.

The concept of adaptive management has, for many ecologists, become a foundation of effective environmental management for initiatives characterized by high levels of ecological uncertainty. Yet problems associated with its application are legendary, and many of the initiatives promoted as examples of adaptive management appear to lack essential characteristics of the approach. In this paper we propose explicit criteria for helping managers and decision makers to determine the appropriateness of either passive or active adaptive-management strategies as a response to ecological uncertainty in environmental management. Four categories of criteria--dealing with spatial and temporal scale, dimensions of uncertainty, the evaluation of costs and benefits, and institutional and stakeholder support--are defined and applied using hypothetical yet realistic case-study scenarios that illustrate a range of environmental management problems. We conclude that many of the issues facing adaptive management may have less to do with the approach itself than with the indiscriminate choice of contexts within which it is now applied.

Conservation of Natural Resources↗

PubMed2002

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

OBJECTIVE: Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management. RESEARCH DESIGN AND METHODS: We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA(1c) testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only. RESULTS: Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged 394.62 dollars for program patients compared with 502.48 dollars for nonprogram patients (P < 0.05). This difference was accompanied by lower inpatient health care use in program patients (mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year) than in nonprogram patients (0.16 and 0.98, P < 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P < 0.05 for both measures). Except for emergency room visits, these differences remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA(1c) testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P < 0.05 for all measures). Among 1,074 patients with HbA(1c) levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level >9.5%, as compared with 79 of 548 (14.4%) nonprogram patients. CONCLUSIONS: In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical costs.

Aged↗

PubMed1990

The CIO and IRM (information resources management) alliance: maneuvering for the competitive edge in hospital information management.

In 1986, Johns noted that "The hospital industry was caught unprepared for the external demands and information needs required in a case-mix reimbursement environment." Lack of a data-processing philosophy and inattention to external forces were cited as having hampered technology upgrade and integration of financial and clinical databases. The intervening years have witnessed a growth of information dissemination in the health care industry concerning information value and resource management. The frequency of appearance of articles on information management in the professional literature and the number of workshops and professional meetings addressing the topic attest to the current visibility of the information resource. Despite this flurry of interest, the industry has not developed its own models of information resources management nor validated its information evolution with accepted management information systems models. While interest in health care information resource management exists, understanding of the complex issues in this area has not developed as one would expect. While there are a myriad of reasons for this, a contributing factor is the lack of a research foundation for development and application of theory and models. Even though various graduate programs exist in medical informatics and biomedical computing, few concentrate on the study of health information resource management from an organizational perspective. Because of this, academic research in the area has been minimal. The scarcity of graduate-level programs has also meant that few individuals have been educated to deal with the challenges of managing the many disparate functional activities associated with health care information resource management. Due to a variety of internal and external forces, extreme demands were placed on the hospital information resource during the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administrators↗

PubMed1990

What makes an effective manager?--health care and general management perceptions.

This paper explores the perceptions of Australian health service managers (and health service management students) regarding the qualities of effective managers, comparing and contrasting these views with those of Australian general managers (and general management students). The study forms part of a wider international project aimed at exploring the role of national culture in managerial behaviour and effectiveness. Overall, the skills dimension was perceived to be more important in terms of managerial effectiveness, particularly amongst health service managers, compared to the other main dimensions of knowledge and learning, beliefs and values and personality characteristics. Decision-making and planning and evaluation were considered to be the most important amongst the range of skills listed, followed by negotiation and conflict resolution. Health service managers rated pertinent technical knowledge more highly than any other aspect in the knowledge and learning dimension, indicating the importance of specialist education for health service managers. Some implications of these and other findings are discussed.

Attitude of Health Personnel↗

PubMedDate not supplied

Pain management. Theological and ethical principles governing the use of pain relief for dying patients. Task Force on Pain Management, Catholic Health Association.

Pain management is a societal problem because of concerns about the use of drugs, the belief that patients are not good judges of the severity of their pain, and an alarming level of ignorance about pain and its treatment among physicians, nurses, and other healthcare providers. The result is that patients suffer pain unnecessarily, even up to the point of their death. Pain management is also a clinical-practice problem. Courses in pain and symptom management are not readily available to medical and nursing students. And in clinical practice, good pain assessment is not easy to accomplish because pain is so subjective. Fortunately, with education, doctors and nurses can vastly improve their ability to assess and manage patients' pain. Additional problems in pain management relate to the manner in which healthcare is provided today: an acute disease-oriented model of hospital care, frequent transfers, fragmented care, inadequate reimbursement, market forces that drive up costs, and maldistribution of clinical services. In improving their ability to manage pain, professionals must understand the difference between pain and suffering, acute and chronic pain, and the sensory and emotional aspects of pain. Guiding principles include Church teaching and ethical principles, such as patient self-determination, holistic care, the principle of beneficence, distributive justice, and the common good. Pain management strategies that will be instrumental in formulating effective responses to these problems include expanding professional and community education, affording pain funding priority, establishing institutional policies and protocols, forming clinical teams, encouraging hospice and home care, and requiring accreditation in pain and symptom management.

Attitude of Health Personnel↗

PubMed2000

[Management of unstable angina: advanced age is still an independent predictive factor of more conservative management after prognostic stratification with stress test].

BACKGROUND AND OBJECTIVE: In the management of ischemic heart disease, elderly patients constitute a subgroup that, despite having a worse prognosis, are usually managed more conservatively. The objective of this study was to evaluate if, in the management of unstable angina, a more conservative attitude in elderly patients is maintained after stratification by exercise test. PATIENTS AND METHODS: The study population is constitude by 859 patients admitted to hospital due to suspected unstable angina that were referred to exercise test after medical stabilization. The management (invasive versus conservative, according to submission to cardiac catheterization or not) of patients was retrospectively studied, comparing patients < or = 70 versus > 70 years-of age. RESULTS: Out of the 859 patients, 156 (18%) were > 70 years old, and the exercise test was positive in 281 (33%). Cardiac catheterization was performed in 494 (57%): 62% in older and 38% in younger patients (p < 0.0001). Other characteristics associated with a more conservative management were: a negative exercise test, > 85% of the maximum heart rate, duration of exercise test more than 6 minutes, female gender, smoking and absence of episodes of rest angina. In the multivariate analysis, the statistically significant characteristics associated with an invasive management were the result of the exercise test (OR for positive result: 4.50; IC 95% = 2.73-7.63; p < 0.0001), the duration of exercise (OR for > or = 6 minutes: 0.51; IC 95% = 0.29-0.88; p = 0.0177), the percentage of the maximum heart rate (OR for > or = 85%: 0.65; IC 95% = 0.42-0.98; p = 0.0391) and age (OR for > 70 years 0.36; IC 95% = 0.20-0.62; p = 0.0004). CONCLUSIONS: In the management of unstable angina, elderly patients constitute a more conservatively managed subgroup even after risk stratification with exercise test.

Age Factors↗

PubMed2004

Clinical management of multiple sclerosis: the treatment paradigm and issues of patient management.

OBJECTIVE: To summarize the conclusions of an expert panel of neurologists specializing in multiple sclerosis (MS) convened for the purpose of creating a treatment algorithm with regard to the clinical management of MS. The panel was sponsored by the Health Science Center for Continuing Medical Education and the University of Medicine and Dentistry of New Jersey and supported by an educational grant from Biogen Idec, Inc. SUMMARY: MS is a chronic demyelinating disease characterized by a variable clinical course. Currently, there is no cure for MS, and the management of MS requires lifelong treatment with disease-modifying agents. Some patients respond well to therapy for many years, whereas others may have aggressive disease that is more difficult to manage. Hence, given the variable nature in the course of MS and patients. response to treatment, neurologists must individualize care for their patients. An MS treatment algorithm was recently developed by a panel of neurologists who are MS experts to provide community neurologists with best-practice protocols for treating and managing their MS patients. The panel of experts categorized MS into 3 different stages, with patients transitioning between the stages based on their response to therapy and disease progression. Stage I represents MS early in the progression of the disease, during which platform drug therapy is recommended (i.e., interferon beta-1b [IFNbeta-1b], IFNbeta-1a, or glatiramer acetate). The results of randomized, controlled clinical trials suggest that IFNbeta is the optimal choice for platform therapy. Despite treatment with platform therapy, it is common for patients to experience some ongoing symptoms and periodic exacerbations of the disease (annual relapse rate of 0.59 to 0.84 on treatment); such relapses should not be considered treatment failures and are best managed with steroids. Stage II represents acute breakthrough disease (i.e., when the clinical activity becomes more frequent or severe). This stage is best managed by the addition of pulse corticosteroids to the platform drug. Stage III represents continued breakthrough disease and is best managed by the addition of immunosuppressants to the platform drug. CONCLUSION: The MS treatment algorithm provides an educational resource for physicians. It should assist all health care professionals involved in the management of MS patients and enhance their ability to improve quality of life for these patients over the course of the disease.

Adjuvants, Immunologic↗

PubMed2005

[Core of the philosophy of management: self-management].

Philosophy is an aspect of metaphysics; while management, by contrast is a practical matter. In this century, this is especially crucial that management philosophy focuses on value and spiritual intelligence. However, the core of pragmatic management is the manager's emotional intelligence. The purpose of this paper is to expound a manager's own positive values and philosophy, as well as the manager's capacity for the management of his or her own emotions. Ultimately, under a spiritually and emotionally intelligent manager, all aspects of an organization--personnel, business issues, physical assets--will interact harmoniously and the organization will advance.

Emotions↗

PubMed2006

The Weight Management Code of Practice of Australia as a framework for the commercial weight management sector.

The Weight Management Code of Practice Australia provides a framework for the diversity of players in the weight management industry. In the current worldwide epidemic of overweight and obesity, the potential for the industry to 'do the right thing', comply with the Weight Management Code of Practice Australia, and assist people with long-term weight loss, is far reaching. The Weight Management Code of Practice in Australia is managed by the Weight Management Council Australia Limited. There are many players in the weight management industry, not all will be eligible for membership of Council but there are many who could be eligible. Ideally, all centres, programs and professionals in the industry should have in place business practices and regimens that comply with the Code. The more members of this industry who are willing to modify their business practices and regimens to comply with the Code, the more accountable the industry will be and the better the products and services will be for consumers. The Code has the potential to be implemented in other countries. The Australian Weight Management Code of Practice can be a model for the rest of the world to establish standards by which this huge industry can be governed.

Australia↗

PubMed2002

The evolution of quality management in state Medicaid agencies: a national survey of states with comprehensive managed care programs.

BACKGROUND: Concern has been expressed about whether managed care health plans can successfully meet the special needs of Medicaid beneficiaries. A 1996 survey indicated that state Medicaid agencies had just begun conducting quality oversight and management. Since then the federal government has released guidelines under the Quality improvement System for Managed Care (QISMC) program to assist states with quality management of managed care programs. In 1999 a follow-up telephone survey was conducted with representatives from 45 states to describe the current state of and changes in quality management activities by state Medicaid agencies for Medicaid beneficiaries enrolled in managed care. RESULTS: The 45 states represented a 50% increase between 1995 and 1999. The number of states enrolling the disabled had doubled (from 15 to 30). Most states collecting data on satisfaction and childhood immunizations fed it back to health plans, although feedback of other measures of access and quality occurred less frequently and fewer states provided information to beneficiaries choosing health plans. Fewer than 25% of states reported having even one health plan demonstrate improvement in individual measures of access and quality except for prenatal care (28%) and childhood immunizations (33%). Fewer than half of the states included contractual penalties in their contracts with health plans, and very few (three or fewer per penalty) had over invoked such penalties. CONCLUSIONS: State Medicaid agencies continue to adapt to their new roles as value-based purchasers of health care. Although increasing numbers of states collect data on satisfaction, access, and quality of care, few states have been able to document improved performance in the health plans they oversee.

Feedback↗

PubMed2003

How managed care has affected mental health case management activities, caseloads, and tenure.

The purpose of this study was to identify changes in case management within public sector mental health, following the implementation of managed care. Case managers in the State of Oregon completed surveys in 1992 and 2000 regarding aspects of case management. Results showed that current case managers are more experienced and expect longer tenure than previously. Caseload sizes have increased. Meanwhile, case managers' activities and functions have not changed across time periods. The results suggest that mental health personnel have changed in the past decade, though the practice of case management has remained largely the same.

Adult↗