Case management for multimorbid patients

Nathalie Versnel, MSc. François Schellevis, MD, PhD

Giel Nijpels, MD, PhD

Caroline Baan, PhD

Background

Co-morbid T2DM patients

Participating in several disease specific management programs

could lead to uncoordinated care.

Case management in addition to disease management

1

DMDM

DiabetesDiabetesCareCare

CMCM

All other All other chronic chronic conditioconditio

nsns

Background

2

Results literature review

– Lower health care costs,

– Higher patients‘ perceived quality of care,

– Higher satisfaction of patients and caregivers

http://dx.doi.org/10.1016/j.healthpol.2012.06.006

Aim

To investigate the effects of a case management program on quality of care for co-morbid T2DM patients.

3

Methods – study design

RCT

- 2 Practice Nurses (PN)

- 230 patients

- 8 practices

- 12 months

Intervention group (n=115)

case management additional to centrally organized managed care (diabetes care)

Control group (n=115)

Only centrally organized managed care4

Methods – population

Co-morbid T2DM patients

Participate in the Diabetes Care System

Included comorbid diseases

- cancer

- chronic ischemic heart disease

- chronic obstructive pulmonary disease (COPD)

- Depression

- osteoarthritis of hip and/or knee

- rheumatoid arthritis

- stroke5

Methods - intervention

Elements of the case management program

- assessing health care needs by Resident Assessment

Instrument (RAI)

- discussing care plan with the diabetes patient

- monthly monitoring

- multidisciplinary meetings if needed

- coordination of care

6

Methods - data collection

Quantitative

- Review of the patients’ medical record at the GP.

- Postal patient questionnaires at baseline, at 3 and at 12

months.

- RAI assessment at baseline and at 12 months.

Qualitative

- Semi-structured in-depth interviews for insight in factors

favoring and hampering implementation of the program. 7

Outcome measures

Primary;

difference between the intervention and the control group, after 12 months in the quality of care as perceived by the patients (CQ-Index for GP care and PACIC)

Secondary;

- quality of care from the professional perspective (quality

indicators)

- health status (change in score on the SF-12)

- diabetes control (Hba1c)

- health care utilization (medication use; number of

contacts with care providers)

8

Situation at present

First patient started February 2011, last patient July 2012

199 patients 10 trained PN's 11 Primary Care Practices

9

Baseline characteristics (n=173)

10

Mean (SD) at baseline

Age in years 67.8 (11.5)

Gender (male) 56.1 %

Etnicity (Western) 97.1 %

Native language (Dutch) 97.7 %

Education level- none/ low- middle- high

35.1%50.0%14.9%

Number of comorbid illnesses 2 (1) Range 1-4

Number of prescibed medication 7.3 (3.2) Range 2-17

Health status (SF-12, scale 0-100)- Mental Component Score- Physical Component Score

49.3 (11.2)34.8 (10.8)

Health care utilization (contacts in past 6 months) 10 (15) Range 0-87

Conclusion

11

Results will be available in 2014

Website study review;

http://dx.doi.org/10.1016/j.healthpol.2012.06.006