title: Effectiveness of nurse case management compared with usual care in cancer patients at a single medical center in Taiwan: a quasi-experimental study.
abstract: BACKGROUND
  In order to improve treatment and care quality for cancer patients, nurse case management model has applied generally in the clinical practice. However there were only few evidence-based studies on the relative benefits in Taiwan. Further analysis and feedback application are needed. The aim of this study is to evaluate the effectiveness of care quality in cancer patients with nurse case management.
  
  
  METHODS
  This study was conducted with a quasi-experimental design in a national medical center in Northern Taiwan. Patients diagnosed as lung, liver, breast, colon, buccal or cervical cancers were eligible for inclusion. A total number of 600 subjects randomly selected from the cancer case management system enrolled in the case managed group, and 600 patients who received usual care were randomly selected from cancer registry and enrolled in the control group. The study instrument was developed to measure care effectiveness, including the rates of patient continuing treatment, non-adherence to treatment, prolonged hospitalization, unplanned readmission, and planned admission for active treatment. The content validity of expert was assessed as 0.9.
  
  
  RESULTS
  The nurse case management significantly decreased the unplanned readmission rate caused by infection (1.5% vs. 4.7% in the control group, p = 0.002). The rate of patient continuing treatment in the institution significantly increased in the case managed group (93.8% vs. 84.8% in the control group, p < 0.001). The planned admission rates in 14 days and in 15-30 days for active treatment also significantly increased in the case managed group (18.4.% vs. 3.9% in the control group and 34.5% vs. 10.4% in the control group, respectively, p < 0.001). The results indicated that nurse case management provided better control in timeliness and continuity of patient treatment.
  
  
  CONCLUSIONS
  This study demonstrated that cancer case management could improve the effectiveness of cancer care services and concretely illustrated a comprehensive model for oncology patients in Taiwan. In addition, the model could be optimized for further application and improvement of cancer care. Future investigations are needed to develop precise and rigorous evaluation to optimize the utilization of cancer case management.
authors.affiliation: Taipei Veterans General Hospital, Taipei, Taiwan. ycchen@vghtpe.gov.tw
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Chen
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Chang
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Tsou
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Chen
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D019090:Case Management / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009732:Nursing Care / Q000592:standards*; D012042:Registries; D013624:Taiwan