Predictive Modeling for Complex Care Management

The subjective nature of pain has always rendered it a point of entry for power and corresponding stratifying processes within biomedicine. The opioid crisis has further exacerbated these challenges by increasing the stakes of prescribing decisions for providers, which in turn has resulted in greater treatment disparities. Using the theoretical frame of cultural health capital (CHC) to account for these disparities in pain management as they unfold at both the macro- and the microlevel, we present findings from an interdisciplinary study of two complex care management programs in urban safety-net hospitals that serve high-utilizing patients. CHC, which considers the ways in which patient–provider interactions reflect and often reinforce broader social inequities, allows for a consideration of power as it circulates through and beyond the patient–provider encounter. Within the current sociopolitical era of pain management, attention must be paid to the stratifying processes that structure how suffering is addressed.

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Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol

Implementation Science ◽

10.1186/1748-5908-5-70 ◽

2010 ◽

Vol 5 (1) ◽

Cited By ~ 18

Author(s):

Tobias Freund ◽

Michel Wensing ◽

Cornelia Mahler ◽

Jochen Gensichen ◽

Antje Erler ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Study Protocol ◽

Care Management ◽

Chronically Ill ◽

Complex Care ◽

Management Intervention ◽

Chronically Ill Patients

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Demand for community-based Case Management in Austria - a qualitative analysis

BMC Nursing ◽

10.1186/s12912-021-00775-0 ◽

2022 ◽

Vol 21 (1) ◽

Author(s):

Alessandra Schirin Gessl ◽

Angela Flörl ◽

Eva Schulc

Keyword(s):

Case Management ◽

Focus Groups ◽

Care Management ◽

Qualitative Content Analysis ◽

Community Setting ◽

Complex Care ◽

Care Providers ◽

Coordinated Care ◽

Care Needs ◽

Complex Care Needs

Abstract Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

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Tailoring Complex-Care Management, Coordination, and Integration for High-Need, High-Cost Patients: A Vital Direction for Health and Health Care

NAM Perspectives ◽

10.31478/201609q ◽

2016 ◽

Vol 6 (9) ◽

Cited By ~ 4

Author(s):

David Blumenthal ◽

◽

Gerard Anderson ◽

Sheila Burke ◽

Terry Fulmer ◽

...

Keyword(s):

Health Care ◽

Care Management ◽

Complex Care

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Impact of complex care management on spending and utilization for high-need, high-cost Medicaid patients

The American Journal of Managed Care ◽

10.37765/ajmc.2020.42402 ◽

2020 ◽

Vol 26 (2) ◽

pp. e57-e63 ◽

Cited By ~ 3

Keyword(s):

Care Management ◽

Complex Care

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Risk Factors and Effects of Care Management on Hospital Readmissions Among High Users at an Academic Medical Center

Care Management Journals ◽

10.1891/1521-0987.17.3.134 ◽

2016 ◽

Vol 17 (3) ◽

pp. 134-139 ◽

Cited By ~ 2

Author(s):

Quang H. Pham ◽

Sara X. Li ◽

Brent C. Williams

Keyword(s):

Hospital Readmission ◽

Care Management ◽

Medical Center ◽

Academic Medical Center ◽

Management Program ◽

Complex Care ◽

Intensive Care Management ◽

Academic Medical ◽

Care Management Program ◽

The Mean

Few studies have examined predictors of hospital readmission among high-using patients enrolled in a behaviorally oriented intensive care management program. The purpose of this case control study was to describe risk factors and the effectiveness of a complex care management program for hospital readmission among vulnerable patients at a large academic medical center. One hundred sixty-three patients enrolled in the University of Michigan Complex Care Management Program (UM CCMP) were hospitalized between January 2014 and March 2015. Sixty were readmitted within 30 days of discharge. Among all patients, the mean age was 51.1 years, 38.7% were non-White, 81.5% had Medicaid and/or Medicare, 50.3% were without stable housing, and 27.6% had significant psychiatric illnesses. Although mostly not statistically significant, multivariable risk of readmission was increased by having twice the mean number of hospitalizations in the last 6 months (odds ratio [OR] = 1.44, 95% CI [1.00, 2.06]), having chronic pain on a scheduled narcotic (OR = 1.49, 95% CI [0.67, 3.35]), and going to a primary care physician within 30 days of discharge (OR = 1.35, 95% CI [0.63, 2.89]). Risk was decreased by going to a specialist (OR = 0.54, 95% CI [0.23, 1.27]) and receiving moderate-intensity CCMP intervention (OR = 0.48, 95% CI [0.20, 1.19]). Among hospitalized high-using patients enrolled in the UM intensive care management program, readmission is likely significantly influenced by medical, behavioral, and social challenges. Care management appears most effective in preventing readmission among patients with mid- rather than high- or low-level needs. These findings at a single program should be explored in further, larger studies.

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