Community-based case management and outcomes in Medicare beneficiaries

This study evaluated the effect of community-based case management (CM) intervention on patient outcomes in Medicare beneficiaries with chronic illness in a rural Midwest region from 2002 to 2004. The relationships between 252 patients' access and clinical outcomes (the number of hospitalizations, length of stay (LOS), and emergency department (ED) visits) and CM were investigated. CM services were provided as four types: high home, high clinic, high telephone, and mixed-care services by nurse case managers. A descriptive, repeated-measurement design was used, and a secondary analysis of a data set containing longitudinal community-based CM data was conducted. The transitional care model and transition theory served as the theoretical background for the study. Descriptive statistics and frequency analysis, t-test, and a repeated-measure ANOVA analysis were used to analyze the data.

Characteristic profiles of the patients were analyzed with their self-care Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores. The patients in this study were relatively healthy on their self-care functional status at the beginning of the study. The four types of CM services were compared with patient-reported clinical outcomes (the self-care ADL, IADL, symptom control, quality-of-life, and personal well-being scores) in each year. Analyses showed that patients' clinical outcomes were similar regardless of the type of CM services in each year. Two years of longitudinal CM intervention greatly affected patient's clinical outcomes and access outcomes. The study found that CM significantly reduced the number of hospital days and influenced patients' quality of life and symptom control. The impact of CM on LOS and ED visits was indeterminate. Further research is needed-including the effect of type and dosage of CM services and outcomes and the development of a comprehensive CM model-to guarantee CM as a core intervention in health care reconfiguration.