title: Flexible client-driven in-home case management: an option to consider.
abstract: Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Canada. cmcwill@uwo.ca
authors.forename: Carol L
authors.initials: CL
authors.lastname: McWilliam
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: Evelyn
authors.initials: E
authors.lastname: Vingilis
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hoch
authors.forename: Catherine
authors.initials: C
authors.lastname: Ward-Griffin
authors.forename: Allan
authors.initials: A
authors.lastname: Donner
authors.forename: Gina
authors.initials: G
authors.lastname: Browne
authors.forename: Peter
authors.initials: P
authors.lastname: Coyte
authors.forename: Karen
authors.initials: K
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D019090:Case Management; D003152:Community Health Nursing / Q000379:methods*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D010358:Patient Participation; D018802:Patient-Centered Care; D011795:Surveys and Questionnaires