Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management
BMC Geriatrics
Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management
Lisa D Van Mierlo 1
Franka JM Meiland 0 1
Hein PJ Van Hout 1
Rose-Marie Dröes 0 1
0 VU University Medical Centre, Department of Psychiatry, Alzheimer Centre, EMGO Institute for Health and Care Research , Valeriusplein 9, 1075 BG Amsterdam , The Netherlands
1 VU University Medical Centre, Department of General Practice and Elderly Care Medicine , EMGO
2 Institute for Health and Care Research , Van der Boechorststraat 7, 1081 BT Amsterdam , The Netherlands
Background: The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions. Methods: A qualitative case study design was used; semi-structured interviews were conducted with 22 stakeholders on the execution and continuation phases of the implementation process. The stakeholders represented a broad range of perspectives (i.e. project leaders, case managers, health insurers, municipalities). Results: The independence of the case management organization in the intensive model facilitated the implementation, whereas the presence of multiple competing case management providers in the linkage model impeded the implementation. Most impeding factors were found in the linkage model and were related to the organizational structure of the dementia care network and how partners collaborate with each other in this network. Conclusions: The results of this process evaluation show that the intensive case management model is easier to implement as case managers in this model tend to be more able to provide quality of care, are less impeded by competitiveness of other care organizations and are more closely connected to the expert team than case managers in the linkage model.
Case management; Dementia care; Implementation; Process analysis
Background
Over the past years, various forms of community-based
case management of dementia have emerged in different
regions in the Netherlands. Unlike disease management,
case management is especially suitable for managing
complex situations that do not fit into a single protocol
and are difficult to manage, such as care for people with
dementia and informal caregivers [
1,2
]. Case management
is characterized by long-term support and guidance both
for community-dwelling people with dementia and their
informal caregivers.
Case managers can provide information, support,
counseling and coordination of care based on the individual
needs of the person with dementia and their informal
caregiver. Case management can therefore be described as
a type of person-centered care. How this care is delivered
and the effects it has depends in part on the way case
management is organized. Worldwide, there are different
case management models that are implemented in various
ways [
3,4
]. These differences are related to e.g. the type
of care case managers provide (e.g. assessment, education,
liaising, counseling), degree of collaboration with other
care professionals, integration in a multidisciplinary team
and professional background of case managers. This
heterogeneity may explain the mixed effects of case
management in dementia to date [
5,6
].
In the Netherlands the urgency of further
implementation of case management has been emphasized in the
recent publication of the ‘Dementia Care Standard’ [
7
].
It describes case management as a standard for good care
and support for people with dementia and their caregivers.
To implement case management successfully, it is
important to know the factors that facilitate or impede this
implementation. Minkman et al. [
8
] were the first to
study success and failure factors of the implementation
of Dutch case management programs. Success factors they
described included investment in a strong provider or care
network and good personal connections with professionals,
expert knowledge of the case managers, and embedding
case management in a multidisciplinary team. Failure
factors described were: distrust of the program by and
competition between local care providers, inadequate
funding and little involvement of primary care doctors.
However, this study did not distinguish between
different types of case management models.
There are two prominent dementia case management
models in the Netherlands [
9
]: the first is the linkage
model that consists of a dementia network in which
multiple case management providers are active and the
case manager acts as a medi (...truncated)