title: Impacts of case management for frail elderly people: a qualitative study.
abstract: OBJECTIVE
  To assess the impacts of different forms of case management for people aged over 65 years at risk of unplanned hospital admission, in particular the impacts upon patients, carers and health service organization in English primary care; and, in these respects, compare the Evercare model with alternatives.
  
  
  METHODS
  Multiple qualitative case studies comparing case management in nine English Primary Care Trusts which piloted the Evercare model of case management and four sites which implemented alternative forms of case management between 2003 and 2005. Data were obtained from 231 interviews with patients, carers and other key informants, and from content analysis of documents and observation of meetings.
  
  
  RESULTS
  All the projects established functioning case management services, but none led to major service reorganization or savings elsewhere in the health care system. Many informants reported examples of admissions which case management had prevented, but overall hospital admissions did not significantly change, possibly due to increased case-finding. Patients and carers valued case management for improving access to health care, increasing psychosocial support and improving communication with health professionals.
  
  
  CONCLUSIONS
  Case management was highly valued by patients and their carers, but there were few major differences in outcomes between Evercare and other models.
authors.affiliation: University of Plymouth, Devon, UK. R.Sheaff@plymouth.ac.uk
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.forename: Ruth
authors.initials: R
authors.lastname: Boaden
authors.forename: Penny
authors.initials: P
authors.lastname: Sargent
authors.forename: Susan
authors.initials: S
authors.lastname: Pickard
authors.forename: Hugh
authors.initials: H
authors.lastname: Gravelle
authors.forename: Stuart
authors.initials: S
authors.lastname: Parker
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000592:standards; D004739:England; D006699:Home Care Services; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D009735:Nursing Homes; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research