Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.
BACKGROUND
Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care.


METHODS
Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis.


RESULTS
One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor.


CONCLUSIONS
The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.
Fraser
Kimberly D
KD
Faculty of Nursing, University of Alberta, Edmonton, Canada. kimberly.fraser@ualberta.ca
Estabrooks
Carole
C
Allen
Marion
M
Strang
Vicki
V
D000416:Alberta; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003152:Community Health Nursing / Q000458:organization & administration*; D003659:Decision Making, Organizational; D003662:Decision Theory; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D020380:Needs Assessment; D009718:Nurse Administrators / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009742:Nursing Theory; D011582:Psychological Theory; D036301:Qualitative Research; D040841:Resource Allocation / Q000458:organization & administration*; D011795:Surveys and Questionnaires