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Case management for at-risk elderly patients in the English Integrated Care Pilots: observational study of staff and patient experience and secondary care utilisation
- Authors:
- ROLAND Martin, et al
- Journal article citation:
- International Journal of Integrated Care, 12(3), 2012, Online only
- Publisher:
- International Foundation for Integrated Care
In response to the perceived need to provide better integrated care, in 2009 the Department of Health appointed 16 Integrated Care Pilots which used a range of approaches to provide better integrated care. The aim of this article is to report on part of the multi-method national evaluation of the 16 Integrated Care Pilots. Specifically, it describes the quantitative analysis of 6 of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. Questionnaires were completed by staff and patients to explore their views regarding the changes. In addition, changes in hospital utilisation and costs were analysed using data on 3,646 patients and 17,311 matched controls. The findings showed that most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Unexpectedly, case management interventions were associated with a 9% increase in emergency admissions. However, there were significant reductions of 21% and 22% in elective admissions and outpatient attendance in the 6 months following an intervention. Overall inpatient and outpatient costs were significantly reduced by 9% during this period.
Healthy IDEAS: implementation of a depression program through community-based case management
- Authors:
- CASADO Banghwa, et al
- Journal article citation:
- Gerontologist, 48(6), December 2008, pp.828-838.
- Publisher:
- Oxford University Press
Healthy IDEAS (HIDEAS; IDEAS stands for Identifying Depression, Empowering Activities for Seniors) is an evidence-based depression program addressing commonly recognized barriers to mental health care for older adults. The purpose of this study was to describe the implementation of HIDEAS and assess its feasibility. Three community agencies in the US implemented the program with 94 eligible older adults who were identified from 348 screened older adults. Program implementation was assessed by using the Core Implementation Component framework, using a client-tracking database, written survey of case managers, focus-group interview with coaches, and agency and project progress reports. Several challenges were identified: clients' reluctance to acknowledge depressive symptoms and difficulty in engaging in behavioural changes; differences among case managers' mental health knowledge, skills, and "buy-in" and difficulty managing limited time; and differences in agency culture that foster in-agency supervision. Implications: Successful adoption and sustainability of HIDEAS are more likely when essential elements of the Core Implementation Component framework are addressed to bring about behavioural changes at all treatment-implementation levels - clients, practitioners, and organizations.
Community-based case management does not reduce hospital admissions for older people: a systematic review and meta-analysis
- Authors:
- POUPARD Nerissa, TANG Clarice Y., SHIELDS Nora
- Journal article citation:
- Australian Health Review, 44(1), 2019, pp.83-92.
- Publisher:
- CSIRO Publishing
- Place of publication:
- Melbourne, VIC
Objective: The aim of this study was to investigate the effectiveness of community-based case management in reducing hospital admissions for older people.Methods: Five databases were searched from inception to March 2018. Trials were included if: (1) participants were community-dwelling adults aged ≥65 years; (2) intervention was community-based case management for ≥3 months; (3) outcomes related to hospital admissions; and (4) the design included a control group. The quality of evidence was independently assessed by two reviewers using the Physiotherapy Evidence Database (PEDro) scale and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were analysed descriptively and using meta-analyses where possible .Results: Nine trials (n=5468 participants) were included in the analysis. Meta-analysis found community-based case management did not reduce hospital admissions (standard mean difference -0.09; 95% confidence interval (CI) -0.27, 0.10), but did reduce emergency department (ED) presentations (mean difference -0.26; 95% CI -0.51, -0.01).Conclusion: Community-based case management intervention may be effective in reducing ED presentations for older people.What is known about the topic?Although community-based case management is common in Australia, little is known about its effectiveness in reducing healthcare utilisation for community-dwelling older people.What does this paper add?The results indicate that community-based case management may decrease the number of ED presentations among older people.What are the implications for practitioners?Patients with high ED presentation rates may benefit from community-based case management to reduce the number of unnecessary ED presentations.
Dementia case management through the eyes of informal carers: a national evaluation study
- Authors:
- FRANCKE Anneke L., et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(5), 2017, pp.642-655.
- Publisher:
- Sage
This paper focuses on the evaluation of dementia case management in the Netherlands, as well as factors associated with positive evaluations of informal caregivers. A survey was completed by 554 informal carers. The majority of the informal carers were older (69% was 55+), and female (73%), and often concerned the partner or adult children of the person with dementia. Eighty percent indicated that the contact with the case manager facilitated their role as informal carer, while 95% or more stated that the case manager showed sufficient understanding, allowed enough space to decide together on how to approach problems in the care, took time to listen to their story, gave sufficient attention to and showed interest in their relative, took their schedule into account and/or kept appointments. Contrary to the expectations, multilevel analyses did not show association between informal caregivers’ care burden and the evaluation of case management. Neither were the period living with dementia and the number of personal contacts with the case manager associated with the evaluations of informal caregivers. However, being the partner of the patient was significantly related (p < 0.05) to a positive overall evaluation by informal carers. These results suggest that sufficient case management resources should be offered and targeted especially towards partners of people with dementia. (Publisher abstract)
Evercare evaluation: final report
- Authors:
- BOADEN Ruth, et al
- Publisher:
- National Primary Care Research and Development Centre
- Publication year:
- 2006
- Pagination:
- 211p., bibliog.
- Place of publication:
- Manchester
Evercare is a form of case management for frail elderly people which originated in the United States and was introduced in 9 pilot primary care trusts in England in 2003 (Airedale, Bexley, Bristol North, Bristol South and West, Halton, Luton, South Gloucestershire, Walsall, and Wandsworth). This document is the final report of an independent evaluation of the Evercare project carried out between 2003 and 2005, which aimed to assess changes in primary and secondary care for older people resulting from the Evercare model, whether the model promoted good clinical practice, and how key stakeholders evaluated the model. The evaluation involved case studies in Evercare sites, including interviews with nurses, GPs, patients, carers and managers, and analysis of documents and Hospital Episode Statistics. The report describes the methodology and sets out the findings and conclusions of the evaluation; it also discusses the policy implications of the project. The key points highlighted were that the Evercare approach to case management provided additional contacts, monitoring and treatment options that were highly valued by patients and their carers, and that although individual examples of avoided hospital admissions were found, there was no overall effect on emergency hospital admissions.
Evaluation of the implementation of PRISMA a coordinated-type integrated service delivery system for frail older people in Quebec
- Authors:
- HEBERT Rejean, et al
- Journal article citation:
- Journal of Integrated Care, 16(6), December 2008, pp.4-14.
- Publisher:
- Emerald
PRISMA is the only example of a co-ordinated type model to be developed and fully implemented with a process and outcome evaluation. This model uses all the public, private or voluntary health and social service organisations involved in caring for older people in a given area. Every organisation keeps its own structure, but agrees to participate in an umbrella system and adapt its operations to the agreed requirements and processes. The PRISMA model was implemented in three areas (urban, rural with or without a local hospital) in Quebec, Canada and an implementation evaluation was carried out using mixed (qualitative and quantitative) methods. Over four years, the implementation rates went from 22% to 79%. The perception of integration by managers and clinicians working in the various organisations of the network shows that most interactions are perceived as at the co-operation level, some getting the highest collaboration level. The perception of the efficacy of case managers was very high. Implementing such a model is feasible, and the decision to generalise it was made in Quebec. This model might be more appropriate for a universal publicly funded health care system like those in Canada, the UK and the Scandinavian countries.
Life was better at home
- Authors:
- CHALLIS David, et al
- Journal article citation:
- Care Plan, 4(1), September 1997, p.17.
- Publisher:
- Positive Publications/ Anglia Polytechnic University, Faculty of Health and Social Work
Describes the Lewisham Case Management Scheme which was one of a number of care management schemes studied by the Personal Social Services Research Unit. Summarises the Unit's findings which show that providing specialist domiciliary services for people with dementia can benefit service users and carers.
Reaching out for help: recommendations for practice based on an in-depth analysis of an elder abuse intervention programme
- Authors:
- STOREY Jennifer E., PERKA Melanie R.
- Journal article citation:
- British Journal of Social Work, 48(4), 2018, p.1052–1070.
- Publisher:
- Oxford University Press
Elder abuse is a growing public health concern with serious and sometimes fatal consequences. Intervention research is lacking despite its potential value to victim protection. This study investigates the first and longest-running social work intervention programme for elder abuse in Canada. The aim of this study is to provide a better understanding of the scope of the problem and needs of the population to inform programme development through the recommendations made. One hundred and sixty-four cases of elder abuse reported from January 2012 to April 2014 were examined. Case characteristics and related recommendations are reported. Third parties reported most abuse, which was typically emotional and financial; polyvictimisation was present in most cases. Intake practices that may have facilitated reporting are described and recommendations to improve victim reporting and confidentiality are made. Victim health problems and dependency were common and many victims lacked support. Perpetrators often resided with victims and had mental health and social-functioning problems. Case management varied in length and several barriers were identified. Multi-agency work is recommended to better manage the needs of the victim, risk factors related to the perpetrator and victim–perpetrator cohabitation. Recommendations to improve the safety of the victim and that of professionals are also made. (Edited publisher abstract)
A journey of improvement: lessons and experiences from using the collaborative methodology in improving older people's services across 12 London Boroughs
- Author:
- UNIVERSITY OF LONDON. King's College. Institute of Applied Health and Social Policy
- Publisher:
- National Health Service. London
- Publication year:
- 2003
- Pagination:
- 31p.
- Place of publication:
- London
The London Older People’s Service Development Programme was a two-year, two phase service improvement programme covering most of London between 2001-2003. Run by the London Directorate of Health and Social Care (LDHSC), it used the ‘collaborative’ methodology, successfully employed in other national service improvement programmes for primary care, cancer, coronary heart disease, medicines management, and more recently emergency care. A total of 25 Borough-based projects took part.
Community-based long-term care case management models for older adults
- Author:
- HYDUK Christine A.
- Journal article citation:
- Journal of Gerontological Social Work, 37(1), 2002, pp.19-48.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Many models of case management exist for helping frail older adults address their significant social and health care needs. This article seeks to understand the common issues associated with the models by comparing the models usingspecific criteria. These criteria include: purpose; target population; inclusion criteria; referral/recruitment; siting/location; type of case management; time period; resource base; personnel/staff/training; interventions/supports; service dosage; non-professional involvement/self-help; evaluation hypotheses/questions;and barriers to success/suggestions for change.