title: Using activity data to explore the influence of case-load size on care patterns.
abstract: BACKGROUND
  A limited case-load size is considered crucial for some forms of intensive case management and many countries have undertaken extensive reorganisation of mental health services to achieve this. However, there has been limited empirical work to explore this specifically.
  
  
  OBJECTIVE
  To test whether there is a discrete threshold for changes in intensive case management practice determined by case-load size.
  
  
  METHODS
  "Virtual" case-load sizes were calculated for patients from their actual contacts over a 2-year period and were compared with the proportions of contacts devoted to medical and non-medical care (as a proxy for a more comprehensive service model).
  
  
  RESULTS
  There were 39 025 recordings for 545 patients over 2 years, with a mean rate of contacts per full-time case manager per month of 48 (range 35-60). There was no variation in the proportion of non-medical contacts when case-load sizes were over 1:20 but there was a convincing linear relationship when sizes were between 1:10 and 1:20.
  
  
  CONCLUSIONS
  Case-load size between 1:10 and 1:20 does affect the practice of case management. However, there is no support for a paradigm shift in practice at a discrete level.
authors.affiliation: Social Psychiatry, University Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, UK. tom.burns@psych.ox.ac.uk
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.forename: Jenny
authors.initials: J
authors.lastname: Yiend
authors.forename: Helen
authors.initials: H
authors.lastname: Doll
authors.forename: Tom
authors.initials: T
authors.lastname: Fahy
authors.forename: Matthew
authors.initials: M
authors.lastname: Fiander
authors.forename: Peter
authors.initials: P
authors.lastname: Tyrer
mesh_terms: D019090:Case Management / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006113:United Kingdom; D016526:Workload / Q000706:statistics & numerical data