Case management for individuals with complex care needs: Factors assisting and hindering implementation
Bibliographic record
Abstract
Context: Case management (CM) is an effective intervention for patients with chronic conditions and complex care needs. While CM often leads to positive outcomes, it has rarely been implemented in primary care in Canada, and little is known of the factors which promote or hinder implementation. Objective: To identify the factors which facilitated or hindered the implementation of CM in primary care from the perspective of nurse case managers, clinic managers and providers. Study Design and Analysis: A secondary analysis of qualitative data from interviews and focus groups conducted throughout the PriCARE program (implementation analysis, telehealth sub-study and realist evaluation). Setting: Primary care clinics in 4 jurisdictions in Canada (New Brunswick, Newfoundland and Labrador, Quebec, and Nova Scotia). Population Studied: Key informants involved in the implementation of CM in primary care clinics: nurse case managers (NCMs); clinic managers and providers. Intervention: A 12-month CM intervention including 4 components: patient needs assessment, care planning, coordination of services, and self-management support. This intervention was completed without additional clinic funding. Outcome Measures: Key informant experiences of and reflections on CM implementation and researcher observations. Instrument: Semi-structured interviews and focus groups with participants, as well as the reflections of the research team during the implementation process. Results: Clinic factors which encouraged the implementation included a holistic collaborative team-based culture, an engaged and supportive clinic manager, the active involvement of care providers, and dedicated and protected time for NCMs to complete CM tasks. Lack of engagement from managers and physicians often led to low recruitment numbers and difficulty completing the intervention. NCMs who did not have set time in their schedules or who did not integrate the CM duties into their regular role struggled to carry out the program. Difficulty coordinating with specialists and external services also acted as a barrier. It was difficult for NCM’s to address individuals’ complex mental health needs due to lack of access to care. Conclusions: The findings from this study provide insight into what worked well in implementing a 12-month CM intervention in a multi case study, as well as areas for improvement from the perspective of nurse case managers, clinic managers and providers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.080 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".