Academic journal article Care Management Journals

Case Management for Long-Term Conditions: Developing Targeting Processes

Academic journal article Care Management Journals

Case Management for Long-Term Conditions: Developing Targeting Processes

Article excerpt

Intensive case management (ICM) is traditionally targeted at patients with complex needs and exists within a wider service context. Targeting is integral to the effi ciency of the service. A process and outcome evaluation of case management was conducted in a large urban area in England between 2007 and 2008. Data from a postal questionnaire, interviews, and resource utilization data of patients within the service are used to explore issues associated with targeting. The study identifi ed various approaches to select appropriate patients. A lack of standardization in assessment was apparent. Reported policies on case allocation, caseload size, and frequency of visiting patients varied. There was little evidence of ICM. Not all patients in receipt of case management admitted to hospital were diagnosed with a specifi c disease or condition. Few patients were recorded as discharged and transferred to another service. We conclude that measures of targeting often focus only on admission to a service and specifi c outcomes and suggest that targeting be considered as a series of interconnected processes rather than static indicators.

Keywords: patient identifi cation; assessment; caseload size; case closure

Internationally, the development of long-term conditions strategies has permitted a variety of forms of case (or care) management arrangements to develop (Applebaum & Austin, 1990; Ikegami, Yamauchi, & Yamada, 2003; Ouwens, Wollersheim, Hermens, Hulscher, & Grol, 2005; Ozanne, 2004; Reilly, Hughes, & Challis, 2010; Tsai, Morton, Mangione, & Keeler, 2005; Weiner, Stewart, Hughes, Challis, & Darton, 2002). In the literature, a distinction is made between intensive care management (ICM), offered to a limited group with greater needs, and a care management approach, which is available across the service (Challis, 1994). Targeting is fundamental to acknowledging and upholding this distinction. ICM is usually targeted at those who are at risk of admission to institutional care and who have complex needs (Applebaum & Austin, 1990; Challis, 1994; Challis, Darton, Hughes, Stewart, & Weiner, 2001; Challis & Davies, 1986). Certain organizational factors are associated with it, including small caseloads, a multidisciplinary assessment of health and social care needs, and a frequently reviewed and adjusted care plan of services to meet these needs developed by a care manager (Challis et al., 2001). ICM also requires established links to other services so patients can be referred if necessary (Challis, Darton, Johnson, Stone, & Traske, 1995). This article explores both the nature and effectiveness of targeting within a case management service for adults with long-term health conditions.

The process of targeting begins at the point of entry, and its purpose is to successfully identify patients who will benefi t most. Here the relationship between case fi nding, screening, and eligibility within a service is complex but important (Stewart, Hughes, Challis, & Weiner, 2003). If appropriate patients are to be referred into the service and their needs successfully met, a balance between these tasks needs to be achieved (Challis & Davies, 1986). The assessment process also contributes to targeting. Assessment has been described as fulfi lling three functions: collecting information about patients' circumstances; evaluating these circumstances and their needs; and constructing a care plan to meet these needs (Hughes, Sutcliffe, & Challis, 2005). Evaluating these circumstances and needs represents the fi nal stage of targeting on entry: ensuring that the most suitable patients are admitted to the service.

Another aspect of the process is targeting within a case management service-"systematically deciding who gets which services, when and in what amounts" (Greene, Ondrich, & Laditka, 1998, p. S229). This is necessary to ensure that patients receive a level of response appropriate to their needs (Hughes et al. …

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