Impact of COVID-19-Related Social Distancing on Delivery of Intensive Case Management.

ABSTRACT: Social distancing due to COVID-19 may adversely impact treatment of adults with serious mental illness, especially those receiving intensive forms of community-based care, in part through weakening of the therapeutic alliance. Veterans and staff at a Veterans Affair (VA) medical center were surveyed 3 months after social distancing disrupted usual service delivery in intensive community-based treatment programs. Veterans (n = 105) and staff (n = 112) gave similar multi-item ratings of service delivery after social distancing, which involved far less face-to-face contact and more telephone contact than usual and rated their therapeutic alliances and clinical status similarly as "not as good" on average than before social distancing. Self-reported decline in therapeutic alliance was associated with parallel decline in clinical status indicators. Both veterans and staff indicated clear preference for return to face-to-face service delivery after the pandemic with some telehealth included.

Case Management and Capacity Building to Enhance Hepatitis C Treatment Uptake at Community Health Centers in a Large Urban Setting.

An estimated 4.1 million people in the United States are infected with hepatitis C virus (HCV). In 2014, the Hepatitis C Community Alliance to Test and Treat (HepCCATT) collaborative was formed to address hepatitis C in Chicago. From 2014 to 2017, the HepCCATT Case Management Program case managed 181 HCV-infected people and performed on-site capacity building at a 6-site community health center (CHC) that produced codified protocols, which were translated into a telehealth program to build capacity within CHCs to deliver hepatitis C care. HepCCATT's innovative approach to addressing multilevel barriers is a potential model for increasing access to hepatitis C care and treatment.

Nursing case management for people with hypertension in primary health care: A randomized controlled trial.

INTRODUCTION: Hypertension is a chronic disease that requires continuous and long-term care to prevent or delay the development of associated complications. Although various interventions for hypertension exist, case management in Brazil's primary healthcare is understudied. We examined nursing case management effectiveness for controlling blood pressure among Brazilian adults with hypertension in the public healthcare system. METHOD: A randomized controlled trial with a 12-month follow-up was conducted at a primary healthcare clinic in southern Brazil. Adult patients with hypertension were randomly allocated to intervention (n = 47) and usual care groups (n = 47). The nursing case management model includes nursing consultations, telephone contact, home visits, health education, and appropriate referrals. Patient outcomes (blood pressure, body mass index, waist circumference, quality of life, treatment adherence) were assessed at baseline and 6- and 12-month follow-up for the intervention group and at baseline and 12-month follow-up for the usual care group. Data were collected from only the intervention group at T6 to avoid contact between the researcher and the usual care group, and to check the care plan and modify it if necessary. RESULTS: After the intervention, the intervention group's blood pressure decreased significantly compared to the usual care group. The differences in systolic and diastolic blood pressure between the groups was -8.3 (intervention)/1.1 (usual care) mmHg (p = .004) and -7.4/-0.6 mmHg (p = .007), respectively. The intervention group had significantly greater improvement in waist circumference (-2.0/1.2 cm), body mass index (- 0.4/0.3), and treatment adherence (4.8/-1.1) than the usual care group (all p < .05). CONCLUSION: Nursing case management in primary healthcare may be effective for improving outcomes among patients with hypertension.

Pediatric integrated behavioral health service delivery models: Using a federal framework to assess levels of integration.

OBJECTIVE: To assess the level of integration of pediatric integrated behavioral health service delivery models (IBHSDM) since it has not been well established. DATA SOURCES: A systematic review of journal databases (e.g., PubMed) and Google searches was used to identify publications. STUDY SELECTION: Studies were included if they examined children who were treated in an IBHSDM. DATA EXTRACTION: The authors extracted data from studies and assessed them for level of integration using a federal conceptual framework. DATA SYNTHESIS: Guided by PRISMA standards, the authors identified 40 journal articles that described 32 integrated delivery models. Five models (15.6%) were rated at integration level 1 or 2 (coordinated care), eight models (25%) were rated level 3 and five models (15.6%) were rated level 4 (co-located care), and fourteen models (43.8%) were rated level 5 or 6 (integrated care). CONCLUSIONS: In general, it is assumed that more completely integrated care will result in higher quality care and reduced costs. Thirteen of the models described (40.6%) had levels of integration of 3 or lower that may be too low to produce desired effects on quality and cost. Future research should address potential barriers that impede the development of models with higher degrees of integration.

Principles of Managing Children with Medical Complexity and a New Delivery Model.

Children with medical complexity (CMC) have warranted substantial individual provider commitment for pediatric management. New drivers have prompted program creation that focuses even greater care on this small, increasingly influential population. These drivers include enhancing care coordination, aligning value-based reimbursement strategies and managing higher patient acuity in non-hospital environments. This article will review management of CMC and highlight the Complex Medical Care Program at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Missouri.

Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis.

AIMS: The aim of this study was to describe case management as experienced by patients with heart failure and their health professionals with the aim of understanding why case management might contribute in reducing hospital admissions. BACKGROUND: Heart failure is a common cause of unplanned hospital admission. The evidence for case management in patients with heart failure for reducing admissions is promising. DESIGN: Systematic review and qualitative evidence synthesis. DATA SOURCE: Searches were conducted in Medline, Psychinfo, Kings Fund database and Cinahl from inception of each database to 16 February 2017. REVIEW METHODS: Robust systematic review methodology was used to identify qualitative studies describing the experiences of patients with heart failure and healthcare providers of case management. Data were synthesized thematically, and analytic themes were developed. FINDINGS: Five studies (six papers) from which nine descriptive themes were used to determine three analytic themes. This synthesis showed that case management provides positive quality of care for patients, increases perceived access to services and creates more time to ask questions and develop trusted relationships. For health professionals, case management enhanced care by improved relationships with both patients and colleagues although concerns remained around resources, training and inter-professional conflict. CONCLUSIONS: This synthesis emphasizes the importance of the quality of being cared for as a patient and caring as a health professional. Case management enhances communication between patients and health professionals, supports patient self-care and self-management and can be an important contributing factor in reducing unplanned admissions for patients with heart failure.

Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.

BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People's Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was >75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies.

Evaluating the Quality of Rural Intensive Case Management Services using Administrative Data: an Exploratory Study.

Assertive Community Treatment (ACT) for people with severe mental illness is an effective approach that is increasingly implemented in rural areas. Low-cost methods of evaluating fidelity to program models are needed to assure services are delivered as intended. In 2007, the Veterans Health Administration implemented an ACT-like Mental Health Intensive Case Management (ACT/ICM) program for SMI veterans in rural areas. This study demonstrates the use of administrative data, reflecting patient characteristics and intensity of service delivery, to characterize services delivered by these programs, to compare them to general mental health programs at the same VA medical centers, and to each other. A total of 298,509 veterans received mental health services at VA medical centers that also operated a rural ACT/ICM program in FY 2012. Altogether 854 (0.29%) received ACT/ICM services for 1 year or more (long term participants) and 259 (.09%) received them for less than 1 year (new entrants). Logistic regression showed ACT/ICM patients were distinguished by diagnoses of schizophrenia, bipolar disorder, and major depression; larger numbers of psychiatric or substance abuse visits; and use of 3 or more classes of psychotropic medication. The model had a high c statistic of 0.91. Propensity scores allowed clear identification of programs most and least conforming to the profile of a "typical" rural ACT/ICM program. Low cost administrative data can be used to identify programs successfully conforming to an empirically derived rural model of ACT/ICM. Further validation of this approach is needed.

Family Physician-Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review.

PURPOSE: Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patient-caregiver dyad and the effects of CM. METHODS: We searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified. RESULTS: Fifty-four studies were included. We identified needs of the patient-caregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care. CONCLUSIONS: There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patient-caregiver dyad.

Quality improvement initiatives in a case management service: case study.

This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

[Impact of standing order prescriptions on the joint follow-up of diabetics in primary care: a case study]. / Retombées des ordonnances collectives dans le suivi diabétique conjoint en soins primaires: une étude de cas.

The burden of chronic disease requires a new organization of medical care and services. Enhancing collaboration among front-line care givers facilitates access to care and optimizes follow-up. As a result, a new organizational structure has been gradually deployed in Quebec since 2003. Family Medicine Groups (FMGs) use a new type of standing order, prescribing details of care. Among 52 FMGs surveyed, an exemplarygroup was identified that most successfully instituted more and higher-impact standing orders. This single case study explored the impact of standing orders used for diabetes follow-up on professional practices, physician-nurse-patient interactions and patient self-management. The data collected and analyzed were derived from more than 200 documents, 15 hours of observation in the clinic, and individual interviews of ten patients, three nurses and eight doctors. Standing ordersformalizing thejointfollow-up ofdiabetic patients both increased professional collaboration and improved patient-professional interactions. As professionals and patients achieved a better consensus, patient self-management was improved. Ultimately, for professionals, standing orders facilitate a better match between the use of their time and skills, and their aspirationsfor practice. Patients are reassured and empowered by ready access to care and their progress in self-management skills. Concrete measures, such as standing orders, modify care delivery by reinforcing professional collaboration, and facilitate patient self-care, in accordance with the Chronic Care Model (CCM).

Star Ratings show hospitals need to improve the discharge process.

For the first time, the Centers for Medicare & Medicaid Services is posting Star Ratings, showing patients' perception of care, on the Hospital Compare website. Ratings are based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and include individual scores on 12 composite measures based on the HCAHPS responses as well as state and national averages. A big gap between patients who reported receiving discharge instructions (86%) and those who said they understood what to do at home (52%) indicates that hospitals need to revise their discharge teaching and make sure patients understand their treatment plan. Case managers need to take the time to fully assess all patients--not just those going to post-acute facilities--to find out their living situations, their support systems, and their need for resources after they go home.

The effect of recent bereavement on outcomes in a primary care depression intervention study.

OBJECTIVES: Although bereavement and depression are both common in older primary care patients, the effect of bereavement on depression intervention outcomes is unknown. We examined whether standard interventions for depression in primary care were as effective for bereaved as for non-bereaved depressed patients. DESIGN: Randomized controlled trial. SETTING: Twenty community-based primary care practices in New York City, greater Philadelphia, and Pittsburgh. Randomization to either intervention or usual care occurred by practice. PARTICIPANTS: Patients aged 60 years or older who met criteria for major depression or clinically significant minor depression (N = 599). Patients who did not complete the bereavement measure or who were missing 4-month data were excluded (final N = 417). INTERVENTION: Study-trained depression care managers offered guideline-concordant recommendations to primary care physicians at intervention sites and assisted patients with treatment adherence. Patients who did not wish to take antidepressants could receive interpersonal psychotherapy. MEASUREMENTS: Bereavement was captured using the Louisville Older Persons Events Schedule. Depression severity was assessed using the 24-item Hamilton Depression Rating Scale (HDRS). Outcomes at 4 months were remission (HDRS ≤7) and response (HDRS reduction ≥50% from baseline). RESULTS: Logistic regressions indicated that, for non-bereaved participants, response and remission were higher in intervention than usual care. However, recently bereaved older adults were less likely to achieve response or remission at 4 months if treated in the intervention condition. CONCLUSIONS: Standard depression care management appears to be ineffective among recently bereaved older primary care patients. Greater attention should be paid in primary care to emotional distress in the context of bereavement.

Performance of Ethiopia's health system in delivering integrated community-based case management.

BACKGROUND: Analyzing complex health programs by their components and sub-components serves design, documentation, evaluation, research, and gap identification and prioritization. In 2012, we developed a rapid methodology to characterize integrated community case management (iCCM) programs, by assessing benchmarks for eight health system components in three program phases. OBJECTIVE. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced, and to compare the benchmarks across the geographical region. METHODS. Six national iCCM experts scored each of 70 benchmarks (no, partial, or yes) and then were facilitated to reach consensus. RESULTS. Overall, iCCM benchmark achievement in Ethiopia was high (87.3%), highest for pre-introduction (93.0%), followed by introduction (87.9%) and scale-up (78.1%) phases. Achievement by system component was highest for coordination and policy (94.2%) and lowest for costing and finance (70.3%). Six regional, countries benchmark assessments, including two from Ethiopia 14 months apart, were highly correlated with program duration at scale (correlation coefficient: +0.88). CONCLUSION: Ethiopia has a mature, broad-based iCCM program. Despite limitations, the method described here rapidly, systematically, and validly characterized a complex program and highlighted areas for attention through government or partners.

Assessment of the monitoring and evaluation system for integrated community case management (ICCM) in Ethiopia: a comparison against global benchmark indicators.

BACKGROUND: Program managers require feasible, timely, reliable, and valid measures of iCCM implementation to identify problems and assess progress. The global iCCM Task Force developed benchmark indicators to guide implementers to develop or improve monitoring and evaluation (M&E) systems. OBJECTIVE: To assesses Ethiopia's iCCM M&E system by determining the availability and feasibility of the iCCM benchmark indicators. METHODS: We conducted a desk review of iCCM policy documents, monitoring tools, survey reports, and other rele- vant documents; and key informant interviews with government and implementing partners involved in iCCM scale-up and M&E. RESULTS: Currently, Ethiopia collects data to inform most (70% [33/47]) iCCM benchmark indicators, and modest extra effort could boost this to 83% (39/47). Eight (17%) are not available given the current system. Most benchmark indicators that track coordination and policy, human resources, service delivery and referral, supervision, and quality assurance are available through the routine monitoring systems or periodic surveys. Indicators for supply chain management are less available due to limited consumption data and a weak link with treatment data. Little information is available on iCCM costs. CONCLUSION: Benchmark indicators can detail the status of iCCM implementation; however, some indicators may not fit country priorities, and others may be difficult to collect. The government of Ethiopia and partners should review and prioritize the benchmark indicators to determine which should be included in the routine M&E system, especially since iCCMdata are being reviewed for addition to the HMIS. Moreover, the Health Extension Worker's reporting burden can be minimized by an integrated reporting approach.

Effect of integrated community case management of common childhood illnesses on the quality of malaria case management provided by health extension workers at health posts.

INTRODUCTION: The Integrated Family Health Program supported the government of Ethiopia to implement the Integrated Community Case Management (iCCM) strategy to control childhood illness of which malaria is a major cause. OBJECTIVE: To assess the effect of ICCM training on quality of malaria case management at health posts. METHODS: . A comparative cross-sectional study was conducted among 170 Health Extension Workers (HEW) providing either integrated or vertical malaria case management for children less than five years of age in 14 woredas (districts) of West Hararghe Zone using a multi-stage sampling procedure. HEWs in seven intervention woredas were trained in malaria case management and rapid diagnostic test (RDT) procedures through iCCM, and HEWs in comparison woredas were trained vertically through the national malaria control program. Performance was assessed using interview, review of registers, and observation of RDT procedure. RESULTS: Intervention HEWs performed better than their counterparts in correct drug prescription (90.8 vs. 81.0%, p = 0.03), treatment duration (97.7 vs. 89.9%, p = 0.001), and treatment schedule (95.4 vs. 75.9%, p = 0.000). Intervention HEWs recorded case management with more consistency than their counterparts (≥ 80% consistency between: classification and assessment [23.0 vs. 3.8%; p = 0.000], classification and treatment [24.1 vs. 7.6%; p = 0.003], and classification and follow up [24.1% vs. 0.0%; p = 0.000]); however, there is room for improvement. CONCLUSION: ICCM training has a positive effect on the quality of malaria case management at the community level.

Effectiveness of supportive supervision on the consistency of integrated community cases management skills of the health extension workers in 113 districts of Ethiopia.

BACKGROUND: Consistency in the adherence to integrated Community Case Management (iCCM) protocols for common childhood illnesses provided by Ethiopia's Health Extension Program (HEP) frontline workers. One approach is to provide regular clinical mentoring to the frontline health workers of the HEP at their health posts (HP) through supportive supervision (SS) following the initial training. OBJECTIVE: To Assess the effectiveness of visits to improve the consistency of iCCM skills (CoS) of the HEWs in 113 districts in Ethiopia. METHODS: We analyzed data from 3,909 supportive supervision visits between January 2011 and June 2013 in 113 districts in Ethiopia. From case assessment registers, a health post was classified as consistent in managing pneumonia, malaria, or diarrhea cases if the disease classification, treatment, and follow-up of the last two cases managed at the health posts were consistent with the protocol. We used regression models to assess the effects of SS on CoS. RESULTS: All HPs (2,368) received at least one supportive supervision visit, 41% received two, and 15% received more than two. During the observation period, HP management consistency in pneumonia, malaria, and diarrhea increased by 3.0, 2.7 and 4.4-fold, respectively. After controlling for secular trend and other factors, significant dose-response relationships were observed between number of SS visits and CoS indicators. CONCLUSIONS: The SS visits following the initial training were effective in improving the CoS.

A national system approach to oncology patient population management across the continuum of care: how we standardized navigation.

The increasing complexity of cancer care has the potential to result in care fragmentation and suboptimal coordination and timeliness to care. In managing the oncology patient population, navigators have the opportunity to provide patient-centered care throughout the cancer care trajectory and to positively impact patient's outcomes. The role of the navigator benefits both the patient and the cancer care team by fostering continuity of care and improved communication. As cancer programs find themselves struggling with the global challenges that surround the evolution of patient's navigation and seeking to provide evidence-based care, Catholic Health Initiatives' National Oncology Service Line developed a system-wide approach to identifying and deploying best practices for navigation across their cancer programs.

Individualized plans of care to improve outcomes among children and adults with chronic illness: a systematic review.

BACKGROUND: Adults and children with chronic illness often require services from multiple providers. Individualized plans of care (IPCs) are sometimes developed to improve care coordination. However, their association with improved outcomes is unknown. METHODS: We searched literature published between January 2001 and October 2011, using Medline, CINAHL, EMBASE, PsychINFO, and bibliographic review. Eligible studies involved an IPC with input from the patient and/or family of individuals with chronic illness, evaluated outcomes, and were conducted in the United States. We assessed evidence quality using Oxford Centre for Evidence-Based Medicine criteria. RESULTS: 15 studies met inclusion criteria. Studies were heterogeneous regarding populations and outcomes examined and were generally low quality. Most described IPC use within a multifaceted care coordination intervention. The strongest evidence links IPC use and symptom improvement in depressed adults; the weakest evidence exists for outcomes in children. Vague descriptions of the IPCs' limited analysis. CONCLUSIONS: Current evidence supporting an association between IPC use and improved outcomes, particularly among children, is sparse. Well-designed evaluations of clearly described IPCs are needed to examine who should be involved in their development, what they should include, and how often they should be updated to improve outcomes of care for this vulnerable population.

Documentation must be complete and accurate.

If discharge documentation isn't complete and accurate, coders may not use the correct discharge status code, which could affect a hospital's reimbursement. Discharge status codes identify where patients go after discharge. If patients go to some settings before the geometric mean length of stay, a hospital may receive reduced reimbursement. The Centers for Medicare & Medicaid Services has also issued a new set of discharge status codes that indicate scheduled readmissions.