Academic journal article Australian Health Review


Academic journal article Australian Health Review


Article excerpt

THE INTENT OF the "Models of Care" section is to provide quality articles relating to a range of models of care. It is also a forum for presenting original research findings, debate and discussion in this area.

As this issue of Australian Health Review features the theme of meeting needs for ongoing care, there are a plethora of care models claiming to be the panacea to effectively treat clients with chronic illnesses and conditions. Many articles conclude that care models (such as case management, disease management, chronic condition self-management and others) assist clients in receiving the level of care they need, when they need it, and where they want it. Yet there is mixed evidence on the impact of "models of care", and searching available peerreviewed literature is not straightforward. For example, some recent studies evaluating case management have found reduction in the risk of institutionalisation1 while others have found that case management makes no difference and costs more for the system.2

Whether the model of care is provided for short-or long term-duration and for varying levels of service needs, there are usually a number of interventions or functions involved. Such functions may include:

Targeting; risk assessment; costing; planning; care coordination; implementation; advocacy; monitoring; evaluation.

While these functions are addressed in the literature, there are few rigorous studies which have discerned which of these functions (if any) affect client outcomes. Shojania et al3 used a meta-regression model to ascertain which functions made a difference to diabetic client outcomes, measured as post-intervention difference in HbA^sub 1c^ values. Quality improvement strategies produced small to modest improvements in glycaemic control.

Case management and team changes were two of the functions analysed. Case management, in this context, encompassed having a person or multidisciplinary team providing coordination of care which was in collaboration or supplementary to the primary care clinician. Team changes had to do with changes to the organisation or structure of the health care team. …

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