How community matrons perceive their effectiveness in case management.

AIM: The aim of this study was to explore community matrons' experience of caseload management and identify situations that may restrict or enhance patient care and outcomes. The Department of Health advises that community matrons should have a caseload of 50, based on the Evercare model from the US. However, there is little evidence to justify this caseload target. METHOD: A phenomenological approach was adopted to analyse data from interviews with six community matrons based in two south west primary care trusts. Maximum variation sampling was used. FINDINGS: There are difficulties in building and maintaining a caseload of 50 complex patients with long-term conditions. The higher the caseload the less effective the community matrons perceived themselves to be in reducing hospital admissions. CONCLUSION: Targets should not be set from similar models such as Evercare. A more integrated approach is required with the service being available 24 hours a day. Further research is required to identify the most appropriate caseload size and the of managing such high-risk patients. Quantitative research would help to determine the effect of variables.

Quality improvement in a primary care case management program.

In this article we describe and evaluate quality monitoring and improvement activities conducted by Massachusetts Medicaid for its primary care case management program, the primary care clinician plan (PCC). Emulating managed care organization (MCO) practices, the State uses claims to analyze and report service delivery rates on the practice level and then works directly with individual medical practices on quality improvement (QI) activities. We discuss the value and limitations of claims-based data for profiling, report provider perspectives, and identify challenges in evaluating the impact of these activities. We also provide lessons learned that may be useful to other States considering implementing similar activities.

Ethics of case management: implications for advanced practice nursing.

The healthcare system is under pressure to provide quality care with less money for a growing and aging populace, and the resulting changes in the system could pose ethical problems for advanced practice nurses. Expanding healthcare needs, the increased use of technology, and dwindling resources all place burdens on advanced practice nurses, who have taken on the role of case manager in an attempt to reduce costs, meet patient outcomes, and provide improved, personalized, high-quality care. This paper explores the ethical concerns that can arise from managed care delivery systems and discusses the role of advanced practice nurses as case managers and the possible implications for nursing practice and research.

Achieving minimum caseload requirements--an analysis of hospital discharge data from 2005-2011.

BACKGROUND: The German Federal Joint Committee (the highest decision-making body of physicians and health insurance funds in Germany) has established minimum caseload requirements with the goal of improving patient care. Such requirements have been in place for five types of surgical procedure since 2004 and were introduced for total knee endoprosthesis surgery in 2006 and for the care of low-birth-weight neonates (weighing less than 1250 g) in 2010. METHOD: We analyzed data from German nationwide DRG statistics (DRG = diagnosis-related groups) for the years 2005-2011. The procedures that were performed were identified on the basis of their operation and procedure codes, and the low-birth-weight neonates on the basis of their birth weight and age. The treating facilities were distinguished from one another by their institutional identifying numbers, which were contained in the DRG database. RESULTS: In 2011, there were 172 838 hospitalizations to which minimum caseload requirements were applicable. 4.5% of these took place in institutions that did not meet the minimum requirement for the procedure in question. The percentage of institutions that did not meet the minimum caseload requirement for complex pancreatic surgery fell significantly from 64.6% in 2006 to 48.7% in 2011, and the percentage of pancreatic surgery cases treated in such institutions fell over the same period from 19.0% to 11.4%. A significant reduction in the number of institutions treating low-birth-weight neonates was already evident before minimum caseload requirements were introduced. For all other types of procedure subject to minimum caseload requirements, there has been no significant change either in the percentage of institutions meeting the requirements or in the percentage of cases treated in such institutions. CONCLUSION: After taking account of the potential bias due to the identification of institutions by their institutional identifying numbers, we found no discernible effect of minimum caseload requirements on care structures over the seven-year period of observation, with the possible exception of a mild effect on pancreatic procedures.

Atención sociosanitaria. Apuntes para el debate / Sociohealth care. Notes for the debate

El debate sobre las diferentes modelos que den respuesta a las necesidades de atención sociosanitaria de las personas dependientes, se ha consolidado en la década de los noventa. Han proliferado documentos, planes y recomendaciones que se relacionan en este trabajo. Sin embargo, escasean las realizaciones prácticas en este ámbito. Se ofrece a continuación un comentario crítico sobre algunos aspectos que continúan siendo objeto de debate: equipos de soporte que garanticen la coordinación, tipología y cuantificación de usuarios y situación de los servicios domiciliarios e institucionales (AU)

The debate on the different models that respond to the needs for sociohealth care of dependent persons has been consolidated during the decade of the 90’s. Documents, plans and recommendations that are related in this paper have proliferated. However, practical performances in this area are lacking. The following offers a critical comment on some aspects that continue to be subject to debate: support teams that guarantee coordination, typology and quantification of users and situations of home and institutional services (AU)