Self-management support was mentioned as an important feature of the process. BMC Geriatr 15, 67 (2015). Available from: http://www.cmsa.org/PolicyMaker/ResourceKit/AboutCaseManagers/tabid/141/Default.aspx, Royal-Decree. The authors declare that they have no competing interests. 2013;61(2):S95–106. The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity. Rev Epidemiol Sante Publique. For our cases, ... and two embedded case studies (mini-cases). All members of the project encode their appointments with beneficiaries and it is accessible through VPN”. A type of study that uses both qualitative and quantitative research methods, includes a main case study comprised of smaller sub- case studies, and is appropriate if the study needs to describe phenomena in detail. An assumption regarding the high turnover rate is that this can both be a result and the cause of a low quality of case management. Paris: Dunod; 1973. The main outcomes under study were the delay of permanent institutionalisation, maintaining or improving physical functioning (ADL [15], IADL [16]), cognitive functioning (CPS [17]), depressive status (DRS [18]), quality of life [19] and the informal caregivers’ perceived burden [20].The overall design of the evaluation is detailed elsewhere [21]. Results were then compared and discussed until consensus was reached. Need fulfillment, need importance, and depressive symptoms of residents over the first eight months of living in a nursing home. 2006;35(5):526–9. ≥ 0.04; [32]). 1995;50(2):M128–33. 0.12 and 0.056 for the two first dimensions, predicting a poor level of explanation (i.e. In a multiple case study you are interest in all about A, all about B, all about C. It is also a multiple case study if you are interest in a specific function of A, a specific function of B etc. Age Ageing. As such the questions were: What are the objectives of the projects? Fourthly, the frontiers between the types of projects were fuzzy. They therefore need care of different providers, from both the health care and the social care sector. https://en.wikipedia.org/w/index.php?title=Embedded_case_study&oldid=982473564, Creative Commons Attribution-ShareAlike License. Zarit SH, Reever KE, Bach-Peterson J. Miscellaneous: closed or adaptive design: ok to change research design if initial suppositions As in other studies [37–40], this study was able to illustrate the usefulness of multiple correspondence analysis (MCA) in detecting and representing underlying structures in a large dataset used to investigate key components likely to explain the effectiveness of case management for frail older people in Belgium. Outpatient Case Management for Adults with Medical Illnesses and Complex Care Needs. Statapress, editor. Article The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In order to be able to evaluate the 22 case management projects, a maximum of four levels of was provided for each of the 23 components. The embedded case study approach is particularly relevant to examination of an environment where the boundaries between the phenomenon of interest and context are not clearly evident. However, the inclusion criteria for the beneficiaries do not seem very adequate (ade1), possibly impairing the benefit the latter could experience from the project. 2014;26(7):1161–70. Article the feedback provided to the general practitioners. As expected, stakeholders of the projects also reported the importance of “soft” outcomes, besides the “hard” outcomes asked for by the NIHDI. Moreover, this facilitated the knowledge of the mutual role definition of the professionals inside these organisations. This was observed through formal partnerships with coordination (home nursing agencies) and community agencies (Public Centres for Social Welfare). 1980;20(6):649–55. This type of social case management can be viewed as using strategies to strive towards integrated care through the use of high-skilled human resources and supervision, likely to delegate clinical components in adequate conditions. Moreover, to evaluate in how far the different projects contributed to delaying institutionalisation, the NIHDI asked a consortium of universities to evaluate the effectiveness of the projects to delay definitive institutionalisation in nursing homes, to maintain or improve the functional status and quality of life while assessing their cost, for the NIHDI, the older people, and the impact on the burden of their main informal caregiver. Three types of projects could be identified, and they are grouped here by the type of response provided to each of the criteria. Furthermore, in the same dimension, financial incentives for general practitioner’s participation was also seen as important, as they are crucial partners in case management. Lawton MP, Brody EM. In 2009 the Belgian National Institute of Healthcare and Disability Insurance (NIHDI) launched a nationwide call to generate innovative forms of care, to enhance the capacities of frail older people to remain at home if they wanted to [11]. number of services delivered per older person, according to their status of dependence). Newbury Park: Sage Publications. We purposefully selected two Belrhiti et al. Beardshaw V, Towell D. Assessment and Case Management: Implications for the Implementation of Caring for People. Which activities are implemented to reach these objectives? However, the identification of sub-units allows for a more detailed level of inquiry. "The case study is preferred in examining contemporary events, when the relevant behaviours cannot be manipulated" (Yin, 2003, p. 7). By contrast, these projects are able to recruit beneficiaries to whom case management would benefit the most (ade3); professionals delivering case management are adequately skilled (ski2), their training is adequately sustained by including external supervisors (int3) and the care provided is supported by software assisting the organisation of the care (reg3) but without prompts to providers (rem0). Dissertation, Johnson & Wales University Lancet. the InterRAI Home Care instrument (HC), that was a cornerstone in the projects [12] and in time spent on case management. An embedded case study is a case study containing more than one sub-unit of analysis (Yin, 2003). This grid was to be used to capture what the stakeholders of the projects believed to be key components explaining the successes or failures of their projects and the likely positive outcomes for the beneficiaries. 1). psychologists or occupational therapists; n = 5 or 23.8 %). CMSA-Case Management Society of A. Moreover, the method aimed at creating a case study database using multiple sources of evidence, thus allowing the analysis and a chain of evidence to be maintained [23]. 54.89 %) of the total inertia. 2014;9:915–28. The threshold was augmented until the single most contributive response was identified, i.e. This explains why the model puts a strong emphasis on the case manager-client relationship [48] A. Busse R, Blümel M, Scheller-Kreinsen D, Zentner A. Tackling chronic disease in Europe, Strategies, interventions and challenges: Copenhagen: WHO; 2010. In the second type of case management, where the focus is also on the integration of the care at a social level, the intervention is likely to be more supported by the input of the other professionals, as they benefit from reflective discussions among peers including professionals from outside their organisation and the information about the beneficiaries is shared and organized thanks to a structured software. TVD, JM, SC and OS participated in the design and coordination of the study. Gerkens S, Merkur S. Belgium: Health system review. The X-axis represents the first dimension and the Y-axis the second one. Springer Nature. The evaluation process started with multiple, embedded case studies of six projects [23]. psychological support by a psychologist or nursing care provided during the night) were still to be paid by the older people. Van Durme, T., Schmitz, O., Cès, S. et al. Sociodemographic factors and health in a population of children living in families infected with HIV in Fortaleza and Salvador. Roland W. Scholz suggests that “case is faceted or embedded in a conceptual grid” which allows to identify key components of human and environmental systems (Scholz 2011, p. Several cases were investigated at several levels of analysis [].The levels of analysis included both the franchisor level and the unit level, as research has shown that studying both is necessary to fully understand the processes and results created within franchise systems []. Therefore, communication flow between professionals about the beneficiaries’ complex health care needs is likely to be more fluent than in the previous group [45]. Google Scholar. On the other hand, inadequate financing of the project, because of over-or more frequently, underestimation of the financial cost of staff, could lead to having to accept higher workloads. Fleisher’s review of “modern” case management models identified four categories of case management, based on dozen different models found in the literature. Templates were used for the organisation of the data. In a further stage, the numbers of projects sharing similar response modalities were calculated. Comparing Dutch case management care models for people with dementia and their caregivers: The design of the COMPAS study. Use of multiple correspondence analysis and cluster analysis to study dietary behaviour: food consumption questionnaire in the SU.VI.MAX. Table 2.1 Dimensions and Classifications of Case Studies Note that an embedded case study allows for a multiplicity of methods that may be They are shown in Table 1. This led us to view these type of projects as clinical case management. 2. J Adv Nurs. 2001;371(9614):725–35. MacNeil Vroomen J, Van Mierlo LD, van de Ven PM, Bosmans JE, van den Dungen P, Meiland FJ, et al. Adequate workforce emerged as an important requirement in order for the project to achieve desired results, i.e. 2012;8(5):426. This information drew upon Ridde and Haddad’s article about pragmatic evaluations of complex interventions [29]. Essay on an ideal student. The use of the data for this study was approved by the Ethics Committee of the Université catholique de Louvain under the reference B40320108337. Other authors however [32, 34] recommend two-dimensional pictures of data, which facilitates data interpretation and this is what we did. In other words, this representation allows viewing the attractivity of the responses within a dimension and their repulsion (or opposition) between these two responses. We defined the case as the relationship between leadership and ‘public service motivation’. PLoS One. Specifically, the paper will discuss the sampling frame suitable for case study, such as single-case (holistic and embedded), multi-case, and a snowball or network sampling procedure. We purposefully selected two high-performing and two low-performing hospitals. PubMed Central Privacy The response modalities were provided in the close vicinity of the first response modality chosen, reflecting an attraction between these responses in the multiple component analysis. Because these were composite scores of the variables, the multidimensionality of the variables was preserved when clustering the responses. (Interview3 case manager, 2012). Terms and Conditions, Scaling ADLs within the MDS. A satisfactory approximation of a type was provided if projects were grouped that shared at least the half of the maximum response modalities of their type [32]. Indeed, at the one hand, if case managers perceive their care being of low quality they will also be dissatisfied by their job, in its turn linked with low retention rates. However in the Belgian mainly fee-for-service system, participating in coordination activities is not adequately financed. Challis D, Hughes J. The process started with a multiple embedded case study design in order to identify the key components of case management. WHO SAGE Survey Manual: The WHO Study on Global AGEing and Adult Health (SAGE). 1996;74(4):511–44. By default, STATA uses Burt’s table, i.e. Page 3 of 7 Embedded Case Study Methods: TYPES OF CASE STUDIES of the case. Case study typologies 6 1. MCA was used to detect and explore relationships between structural and process components and offering statistical results that can be seen both analytically and visually. Correspondence to All authors reviewed and approved the final version of the manuscript. This was approximated by the degree to which the concerns of the older people and their informal caregivers were taken into account in the care planning and the degree to which they were involved in multidisciplinary meetings. statement and Which mechanisms can explain a potential impact on the frail older people or their informal caregivers’ outcomes? Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Two dimensions were retained for the MCA. As for the use of the grid in other countries to evaluate the type of case management, the wording of the items of the grid may need refinement as to be applicable in other countries. functioning, not entities we are likely to identify as cases. must follow a “replication” design . The results of the performance of these programmes are presented in the full report [22]. The teams consisted of (a) only nurse case managers (n = 7; i.e. As in many high-income countries, the Belgian healthcare system is considered to be complex for people who need long term care [1]. This means that the information about the available care agencies and reimbursement statuses is scattered around different levels, changing all the time and very confusing for the care providers, and all the more for the older people and their families. Moreover, once the care providers have been identified by the beneficiaries, their intervention needs to be integrated, so that it is not overlapping and that one care provider knows and realizes what the other care provider does [6]. However, the preference was for a community nurse, who is supposed to [1] be trained to care for frail older people in a holistic perspective and [2] have a good knowledge of the resources within the local system, including a clear view of other (health and social) care providers’ roles. 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