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Active case finding with case management: the key to tackling the COVID-19 pandemic
COVID-19 was declared a pandemic by WHO on March 11, 2020, the first non-influenza pandemic, affecting more than 200 countries and areas, with more than 5·9 million cases by May 31, 2020. Countries have developed strategies to deal with the COVID-19 pandemic that fit their epidemiological situations, capacities, and values. We describe China's strategies for prevention and control of COVID-19 (containment and suppression) and their application, from the perspective of the COVID-19 experience to date in China. Although China has contained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and nearly stopped indigenous transmission, a strong suppression effort must continue to prevent re-establishment of community transmission from importation-related cases. We believe that case finding and management, with identification and quarantine of close contacts, are vitally important containment measures and are essential in China's pathway forward. We describe the next steps planned in China that follow the containment effort. We believe that sharing countries' experiences will help the global community manage the COVID-19 pandemic by identifying what works in the struggle against SARS-CoV-2.
Journal Article
Does the degree of limitation in activities of daily living in geriatric patients influence the amount of care and case management required? An analysis from the RubiN project
Background
The number of people in Germany over the age of 70 will increase significantly over the next 10 years. This will be accompanied by an increase in geriatric diseases and disabilities. An important goal for many geriatric patients is to remain in their own homes for as long as possible, while making use of support services. To achieve this, patients with limitations in their daily activities and in need of geriatric care should be identified as early as possible. The RubiN project implemented assessment-based care and case management for geriatric patients in physician networks in Germany. To support future planning, the present analysis investigated whether the intensity of case management increases with increasing limitations in patients’ activities of daily living.
Methods
Using the Barthel Index, an assessment tool to record patients’ ability to perform activities of daily living, patients’ current limitations were assessed for ten activities (eating; sitting up and moving; washing; toileting; bathing/showering; getting up and walking; climbing stairs; dressing/undressing; bowel incontinence; urinary incontinence). For each item, the score (0 to max. 15 points) is determined and added to the Barthel Index score (max. 100 points). Counselling and coordination services provided by case managers were documented according to medical, nursing, therapeutic and social counselling content. Linear multivariate analysis was performed to determine whether the Barthel Index score was a determinant of the intensity of care and case management.
Results
Two thousand three hundred six patients in the RubiN intervention group (65% female; mean age 81.5 years (SD 5.6)) were included in the analysis. 74% of these patients achieved a Barthel Index score between 100 and 85 points at baseline, and correspondingly, 26% of the patients had a Barthel Index score of 80 points or less. Problems with ‘bathing/showering’, ‘getting up and walking’, ‘climbing stairs’, ‘dressing/undressing’ and ‘controlling urination’ were the most common reasons for not achieving the maximum Barthel Index score of 100 points. A total of 26,833 patient contacts were documented by the care and case manager. On average, patients received 11.6 contacts (SD = 9.1). Social (31.8%) and medical (26.3%) counselling and coordination services were provided in the majority of contacts. “Therapeutic counselling content” and “nursing counselling content” were provided in 21.7% and 20.1% of contacts, respectively. Multivariate analysis showed a significant correlation between an decreasing Barthel Index and a higher number of contacts with the care and case manager.
Conclusions
The Barthel Index score can be used to predict the intensity of care and assistance needed by geriatric patients. The scores provide a good basis for planning and implementing care and case management.
Trial registration
German Clinical Trials Register, ID: DRKS00016642. Registered on 29.10.2019—retrospectively registered.
Journal Article
Effectiveness of Case Management for Homeless Persons: A Systematic Review
We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.
Journal Article
Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar
BackgroundExpanding malaria community case management (mCCM) to all ages could shift the point-of-care to the community leading to improved healthcare access in underserved populations. This study assesses the economic viability of such an expansion in Farafangana district, Madagascar.MethodsA cluster-randomized trial was conducted across 30 health centres and the 502 community health workers (CHW) in their catchment areas, with the intervention arm implementing the age-expanded mCCM intervention. CHWs across both arms received training, supplies, and supervision to manage malaria. An economic evaluation assessed cost-effectiveness from health sector and societal perspectives, measuring outcomes in disability-adjusted life years (DALYs) averted. The impact of CHW compensation and economic risks were evaluated using sensitivity analyses.ResultsWithout CHW compensation, annual costs were $794,000, primarily for antimalarials and diagnostic tests. Incremental cost-effectiveness ratios (ICERs) per DALY averted ranged from -$21.86 to $212.42. From a societal perspective, the ICER was -$135.64, and -$243.29 including mortality benefits, meaning the intervention was cost-saving. The programme could avert 99.6 deaths and 3,721.7 DALYs annually, yielding $1,172,283 in net economic benefits. Sensitivity analyses supported these findings.ConclusionsAge-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resource-limited settings.
Journal Article
Industrial and managerial solutions for tourism enterprises
\"This book focuses on the latest developments on management in the tourism and hospitality industries\"-- Provided by publisher.
Book
A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools—What Works, for Whom, and under What Circumstances?
Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person’s characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person’s recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.
Journal Article