Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

BMC Geriatrics, Jul 2014

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.

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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)


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Lisa D Van Mierlo, Franka JM Meiland, Hein PJ Van Hout, Rose-Marie Dröes. Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management, BMC Geriatrics, 2014, pp. 84, 14, DOI: 10.1186/1471-2318-14-84