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The description of case management in research and clinical practice is highly variable which impedes quality analysis, policy and planning. Case management makes a unique contribution towards the integration of health care, social services and other sector services and supports for people with complex health conditions. There are multiple components and variations of case management depending on the context and client population. This paper aims to scope and map case management in the literature to identify how case management is described in the literature for key complex health conditions (e.g., brain injury, diabetes, mental health, spinal cord injury). Following literature searches in multiple databases, grey literature and exclusion by health condition, community-based and adequate description, there were 661 potential papers for data extraction. Data from 79 papers (1988–2013) were analysed to the point of saturation (no new information) and mapped to the model, components and activities. The results included 22 definitions, five models, with 69 activities or tasks of case managers mapped to 17 key components (interventions). The results confirm the significant terminological variance in case management which produces role confusion, ambiguity and hinders comparability across different health conditions and contexts. There is an urgent need for an internationally agreed taxonomy for the coordination, navigation and management of care.
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Lukersmith, S et al 2016 What is Case Management? A Scoping and
Mapping Review.
International Journal of Integrated Care,
16(4): 2,
pp. 1–13, DOI:
* Faculty of Health Sciences, Centre for Disability Research and
Policy, University of Sydney, Sydney, Australia
Mental Health Policy Unit, Brain & Mind Centre, University of
Sydney, Sydney, Australia
Corresponding author: Sue Lukersmith PhD
What is Case Management? A Scoping and
Mapping Review
Sue Lukersmith*,, Michael Millington* and Luis Salvador-Carulla*,
The description of case management in research and clinical practice is highly variable which impedes
quality analysis, policy and planning. Case management makes a unique contribution towards the integration
of health care, social services and other sector services and supports for people with complex health
conditions. There are multiple components and variations of case management depending on the context
and client population. This paper aims to scope and map case management in the literature to identify
how case management is described in the literature for key complex health conditions (e.g., brain injury,
diabetes, mental health, spinal cord injury). Following literature searches in multiple databases, grey
literature and exclusion by health condition, community-based and adequate description, there were 661
potential papers for data extraction. Data from 79 papers (1988–2013) were analysed to the point of
saturation (no new information) and mapped to the model, components and activities. The results included
22 denitions, ve models, with 69 activities or tasks of case managers mapped to 17 key components
(interventions). The results conrm the signicant terminological variance in case management which
produces role confusion, ambiguity and hinders comparability across dierent health conditions and
contexts. There is an urgent need for an internationally agreed taxonomy for the coordination, navigation
and management of care.
Keywords: case management; complexity; care coordination; integrated care; taxonomy; scoping
Case management, also known as care coordination is a
complex integrated health and social care intervention
and makes a unique contribution to the health, social care
and participation of people with complex health condi-
tions.[1–4]. In the 1960’s case management emerged in
response to the de-institutionalisation of large numbers
of people with severe mental health conditions who
required referral to outpatient health and other commu-
nity services. During the 1970’s and 1980’s, the increas-
ing cost of health care and de-centralisation of health
services influenced the role of case managers [5, 6]. Since
the 1990’s, case management has existed in a range of set-
tings including acute, post-acute hospital, rehabilitation,
long term care and community-based settings. Case man-
agement tasks are now performed by people from various
disciplines, for people with different problems in diverse
contexts and communities. These multiple interdepend-
ent and interacting parameters of case management pro-
duce variability in the description of case management
[5, 7–9]. The significant terminological variance, lack of
understanding and a common language for case manage-
ment and care coordination has impeded quality analysis,
policy and planning [4, 10–12]. There is an urgent need
for a common international language, but which first
requires an understanding of the terms used to describe
case management in the literature.
There are multiple parameters that influence case man-
agement. Case management operates in very different ser-
vice sectors (health, social, correctional, work/vocational,
veterans, legal sectors) and different settings (public sec-
tor, private and non-government organisations) and with
different community and support resources (high and
low resource settings). Its presence in diverse contexts
demonstrates the importance of case management in the
horizontal integration of care across health services, social
services and other sectors as well as the vertical integra-
tion across primary, community, hospital and tertiary
health care services [13].
In the health sector, case management and care coordi-
nation occurs within an inpatient setting, or mobile and
community-based. In this scoping review we only consid-
ered community-based case management. Community-
based case management is a mobile rather than office
based health service. Case manager contact with the cli-
ent (and/or their family) may occur in a different setting
such as the client’s home, workplace or other community
Lukersmith et al: What is Case Management? A Scoping and Mapping ReviewArt. 2, page 2 of 13
venue as considered appropriate by the case manager and
client. Community-based case management is the most
holistic and person-centred of the approaches (model) as
it meets at the junction of the client in their own context.
Due to its holistic and comprehensive approach, commu-
nity-based case management is also likely to involve most
of the components of case management of other models
that have a narrower focus.
Health sector case managers are from different disci-
plines (e.g. nursing, occupational therapy, physiother-
apy, psychology, rehabilitation counselling, social work,
speech pathology) and different practice areas (social
and welfare, primary care). Further, there are a number
of case management models and theories underpinning
practice approaches, due in part to the different sectors
where case management operates, the age and health
conditions of the client [9]. Hence, both in practice and
the literature, a range of names are applied to the role
and tasks of a case manager such as: community/care
coordinator, support facilitator or broker, case moni-
tor, discharge planner, planning facilitator, case worker,
clinical/rehabilitation case manager. Other client charac-
teristics and temporal factors (e.g. whether the client’s
problem is new, acute or chronic) also affect the tasks
and actions of the case manager. All these different fac-
tors related to the case manager, client and context influ-
ence what case managers do (i.e. case management tasks
as interventions). Whilst there are differences between
case management tasks and context, there are also simi-
larities, yet there is no common language to describe
these variations.
In spite of the abundance of literature on case manage-
ment in all its forms, case management descriptors are
often non-existent or poorly described with mixed con-
cepts and constructs. There appears to be no consensus
on what is, and importantly what is not case manage-
ment. The heterogeneity, complexity and inadequate
descriptions of the components of case management
demands a flexible exploratory approach and considera-
tion of a breadth of literature compared to the methods
of a focused and narrower systematic review. This review
aims to characterise and map how case management has
been described in the literature. The review did not seek
to assess the quality, nor synthesise the evidence on effec-
tiveness of case management interventions. The focus in
this research programme was on the components and
definitions. It is the first step of a larger study to develop
a taxonomy, a knowledge map and common language for
community-based case management. Community-based
case management was the focus because it is likely to con-
tain elements of other approaches. People with key com-
plex and chronic health conditions were selected, as case
management is frequently used to support their manage-
ment and the integration of their care.
Aim of the research
The objective of this study was to scope and map ‘How
case management is described in the literature’ in particular
the definition, the theoretical basis, the components and
activities (interventions) performed by the case manager.
Theory and Methods
Study design
The study design was a scoping and mapping review. As
exploratory research, scoping reviews are particularly
appropriate when the area is complex, and used to map
the key concepts underpinning a research area [14]. A
scoping study aims ‘to map the literature on a particular
topic or research area and provide an opportunity to iden-
tify key concepts; gaps in the research; and types and sources
of evidence to inform practice, policymaking, and research’
(p. 8) [15]. A scoping review balances the feasibility of the
literature search with the breadth and comprehensiveness
in the scoping process [16].
The scoping review used five of the six steps in the
framework articulated by Arskey et al [17] and extended
by Levac [16] which are: 1) identifying the research ques-
tion; 2) identifying relevant studies; 3) study selection; 4)
charting (mapping) the data; 5) collating, summarizing
and reporting the results. Consistent with many scoping
reviews, quality appraisal was not undertaken as the focus
was on language and descriptions of the concepts and
components of case management rather than the meth-
odology, outcomes and efficacy of the included studies
[15, 16, 18–20].
Scoping and mapping methodology
We used an iterative process in the scoping review that
allowed for flexibility in the search, reviewing and map-
ping steps. A flexible approach was necessary due to
the diversity in the terms around case management, the
model or approach taken, the contexts in which it oper-
ates and the health conditions of the recipients of case
management. The steps taken for the scoping review are
outlined below:
1. The research question
The main research question was ‘How was case manage-
ment described in the literature’. The sub-questions were:
I. How was case management for complex and
chronic health conditions, described in the litera-
ture (brain injury, diabetes, mental health, spinal
cord injury)?
II. What was the theoretical basis (the model) (if any)
linked to the case management approach?
III. What were the components, and activities per-
formed in case management; and how are they
2. Identify relevant studies
This scoping study used quantitative, qualitative research
literature as well as the grey literature. Peer reviewed
papers provide information from observational and
experimental research. Grey literature provides informa-
tion from expert practice knowledge and expert experi-
ence knowledge [21] . In this study we consider grey litera-
ture to be literature ‘produced at all levels of government,
academics, business, industry in print and electronic for-
mats, but which is not controlled by commercial publishers
[22]. It includes papers, reports, technical notes or other
documents produced and published by governmental
Lukersmith et al: What is Case Management? A Scoping and Mapping Review Art. 2, page 3 of 13
agencies, academic institutions, professional associations
such as case management societies, and other case man-
agement organisations and groups that develop standards
or describe services and the activities of case managers.
The search terms and strategy were developed, trialled and
discussed then refined with the co-authors and an informa-
tion specialist. Over three meetings, the co-author team
reviewed examples of the literature and refined the selection
of studies. This refinement involved combining key words for
case management and key words for definition in the final
search strategy with limits to specific health conditions. Our
decisions on key words and limits are outlined below:
– The variation in names, and complexities of contexts
and health conditions posed challenges to systematic
searching across multiple databases. We collectively
identified the relevant descriptors of case manage-
ment for the key word search terms based on our
familiarity with the literature and community-based
case management context.
– There were no limits on the type of study as the
range of literature of interest included qualitative,
quantitative intervention and non-intervention stud-
ies for key health conditions, reports on case man-
agement standards, service descriptions, literature
reviews and theoretical papers.
– Literature on case management not provided in the
community was excluded. However, research papers
and grey literature that referred to general case man-
agement activities and actions were included.
– The number of descriptions for case management
required limits established for the range of health
conditions. Five complex or chronic health condi-
tions were included: brain injury, diabetes, mental
health conditions and spinal cord injury. Brain injury
was included as it is complex health condition and
potentially impacts multiple domains of health. It
was also of interest to the industry partner (Lifetime
Care) involved in the larger study [23]. Mental health
conditions were included because of the complex im-
pact of the conditions but also because of its history
in case management. Diabetes was included as it is
a common chronic health condition. Although less
common, spinal cord injury was included as it pro-
vides its own set of unique challenges around long
term community-based and integrated supports.
Multiple databases were searched for published literature,
complemented by searches on key organisation websites
and snowballing with hand searching of references lists.
The database search was carried out in Week 3 July 2013.
The databases were Medline, Cochrane, OTseeker, and
PsycBITE. The grey literature key websites searches were
conducted in August 2013 and February 2014. The organi-
sational websites were: Australia: Case Management Soci-
ety of Australian and New Zealand (CMSA); Transport
Accident Commission (TAC); Lifetime Care and Support
Authority (LTC); National Disability Insurance Agency
(NDIA); WorkCover Authority (NSW), Brain Injury Rehabil-
itation Directorate (New South Wales – NSW); Department
of Health NSW; Canada- National Case Management Net-
work; United Kingdom (UK) – Case Management Society of
the United Kingdom (CMSUK); British Association of Brain
Injury Case Managers (BABICM); National Health Service
(NHS); United States of America (USA) Agency for Health-
care Research and Quality; Commission for Case Manager
Certification; Case Management Health System; Case
Management Society of America; American Case Manage-
ment Association.
The limits were English language, humans with no lim-
its on study type. The inclusion criteria were:
– No limits on publication dates (Medline 1946- Week
2 July 2013)
– Community-based case management
– Case management related to health conditions of
brain injury, diabetes, mental health conditions,
spinal cord injury
– A definition of the case management and description
of the actions, activities, interventions.
3. Study selection
The authors agreed that an iterative process to the
exclusion, selection of studies and data extractions was
appropriate. In order to manage the copious amounts
of literature located, a hierarchy of steps for the exclu-
sion of literature was developed in consultation with
co-authors. A bibliographic manager database (EndNote
X7) supported the management of the body of literature
and exclusion process. The steps for exclusion after the
removal of duplicated papers were:
i. Exclusion by health conditions, social issues (e.g.
ex-prisoners or offenders, homeless persons), single
health conditions in low health service resource
settings (e.g. Malaria in a developing country),
ii. Exclusion by case management setting (inpatient,
acute care or residential settings such as nursing
home, correctional institution), telehealth (no face
to face).
iii. Exclusion because of inadequate (or absence) of a
description of case management, the case manager
actions or interventions.
4. Mapping the data (charting)
The scoping review involved conceptual mapping to the
point of saturation when no new descriptions, concepts
or components were identified [17, 24]. The focus was
on the components and definitions of case manage-
ment interventions. The information was extracted and
stored on an Excel spreadsheet for data management
and to enable numerical summation and qualitative
analysis. SL extracted data from a sample of 6 papers,
which was then reviewed and checked by LSC and MM.
The information variables to be extracted were then
revised and reduced in agreement with all authors. SL
continued with the data extraction and mapping. The
final extraction table was reviewed by all authors. Obvi-
ous inconsistencies noted were discussed and revisions
Lukersmith et al: What is Case Management? A Scoping and Mapping ReviewArt. 2, page 4 of 13
Extraction and mapping of the case management
information began at a global level of the country and
type of paper, followed by high level information on the
model or approach, theoretical basis, then more detailed
components and then finally the description of these com-
ponents. The final variables mapped were: paper author,
year of publication, title, type of study where relevant (or
paper), health condition of population, country of study,
name of case management model, linked theoretical basis,
case management definition, components of case man-
agement, descriptors, actions/activities described (some-
times called steps, activities, actions or interventions in
the literature) and additional comments. The mapping of
information was done to the point of saturation, where
no new information (concepts, descriptions, components)
were identified. Once it was apparent that no new infor-
mation was extracted, a further six papers were reviewed
and data extracted and mapped, to ensure that the point
of saturation had been reached.
5. Collating, summarizing and reporting the results
The information and mapping results from the studies
were collated, analysed, summarised and reported. The
results were also used as one step in a larger study to
develop a taxonomy on case management [23].
Our search yielded a total of 6,847 peer reviewed research
study papers and 22 grey literature papers, a total of 6,869
references. This was reduced to 6,314 after duplicates
were removed (see Figure 1 for a summary of the screen-
ing and eligibility process). After reviewing the titles and
abstracts from the search results for health condition
(excluded n = 3,600), and removing practice context other
Figure 1: Flow of Study Selection.
Lukersmith et al: What is Case Management? A Scoping and Mapping Review Art. 2, page 5 of 13
than community-based (excluded n = 1,199), and finally
removing those with inadequate description in the paper
(excluded n = 854), we had 661 potential references for
data extraction and mapping. A total of 12 grey literature
papers and 61 randomly selected research papers were
included in the data extraction and mapping to the point
of saturation, when no new information was provided. We
selected the grey literature papers because of their focus
and the content related to the components to be mapped
(model, definition, description of activities or interven-
tions by case managers), such as model descriptions or
statements from professional case management associa-
tions. To ensure the point of saturation was reached, the
data from a further 6 research papers was extracted and
mapped making a total of 79 papers.
The papers analysed included 65 papers from peer
reviewed journals published 1988–2013 and 14 papers
from the grey literature. Appendix 2 provides the
details of the 79 included papers. Table 1 describes
the global analysis of the papers. In 63 papers there
was 10 different countries of focus and 14 there was an
international perspective (e.g. literature review). There
were 26 papers on mental health, eight on diabetes or
chronic/long term health conditions, 12 brain injury,
two on spinal cord injury and 31 were not related to
specific health conditions. There was one systematic
review, 42 qualitative research methods papers, 7 inter-
vention studies, 11 theoretical papers, 5 editorial per-
spectives or expert opinion, 11 papers were practice
guidance and professional association standards and
two conference papers.
The next layer of data extraction resulted in an increas-
ing level of detail on case management as described in the
literature. Twenty-three specifically identified definitions
of case management, (rather than general statements) are
provided in Appendix 3. Some definitions were repeated
Source of the paper
Published papers (n =
Grey Literature (n = 14)
Country of focus
Australia 7 9
Canada 1 1
Germany 1 0
Hong Kong 1 0
Japan 1 0
New Zealand 0 1
Spain 1 0
Sweden 1 0
United Kingdom 5 1
United States America 33 2
International 14 0
Health Condition
Mental Health 26 0
Diabetes/chronic or
long term health condition
8 0
Brain injury 8 4
Spinal Cord Injury 2 0
Not specic 21 10
Type of paper/study
Systematic review 1 n/a
Qualitative study (includes literature review) 40 2
Intervention study (includes study protocols) 7 n/a
Theoretical paper 11 n/a
Editorial/perspective/ expert opinion 5 0
Practice guidance/standards 110
Conference paper 0 2
Table 1: Description of the mapped papers.
Lukersmith et al: What is Case Management? A Scoping and Mapping ReviewArt. 2, page 6 of 13
in a number of papers, for example a case management
society definition was used in a number of papers.
We found descriptions of different models and theoreti-
cal descriptions of the case management approaches in
23 papers. These were mapped to five different models.
Exploration on the most common or frequently adopted
model was not in the study scope. In some instances,
there was a specific model or theoretical basis. For other
papers, the approach was broadly described. On this basis,
we could map the approach to a model. In other papers
several models were discussed (e.g. systematic review).
There was a total of 57 papers which did not identify the
theoretical basis of the case management approach nor
refer to a model. The mapped models of case manage-
ment, related terms, theoretical description and case man-
agement features are provided in Table 2. In this table, we
have not provided examples of papers providing a descrip-
tion as many papers such as literature reviews, opinion
or theoretical papers and systematic reviews referred to a
number of these models or their variations.
The key components of case management described in
the papers were extracted. Terms used for these compo-
nents include activities, functions, tasks, responsibilities,
duties, steps and interventions, standards. Across the 79
papers, we mapped 69 of the various terms used in the
literature to 17 component headings, which were broadly
defined. Only examples of the terms extracted from the
literature and mapped to the component are provided in
Table 3.
The results of the scoping and mapping review confirms
that there is a huge body of peer reviewed and grey litera-
ture on case management, yet there is significant termino-
logical variance. Following literature searches, exclusions
by health conditions, case management context (com-
munity-based) and papers with inadequate descriptions
we extracted data and mapped the components of case
management from papers (n = 79) to the point of satura-
tion. There was a broad range of literature included in the
study (quantitative, qualitative, theoretical and practice
guidance papers) and from 11 countries and international
perspectives (n = 14).
The mapping of extracted data was complicated because
of the variability in the language to describe case manage-
ment. There was heterogeneity in the descriptions, terms
and phrases to describe the models, which reflects the dif-
ficulties in the articulation of the differences and similari-
ties between the models and the interventions provided
by case managers. For the purposes of this scoping review,
we mapped the models described to five key models of
case management based on a theoretical description of
each. Whilst there are more than five case management
models, many are variations, adaptations and interpreta-
tions of a model to the specific context.
We extracted 69 components in the literature to describe
what case managers do (the interventions/activities). We
identified 17 key components and mapped the 69 descrip-
tions to these. Each key component had multiple different
but related terms to describe the intervention. There was
also complexities mapping of the components (activities
and interventions) performed by the case manager. In
the literature, there was semantic confusion between the
components (interventions) of case managers with skills,
standards, aims and objectives. For example, ‘stable per-
son- invested but not involved’ [54] is a description of a
standard or skill of the case manager (the ‘how’) rather
than a component of case management (the ‘what’ is
done). The component descriptions were also variously
defined from different perspectives of the client, case
manager, project or team organisation, program, service
or organisation. For example, the description of ‘gate-
keeper’ (clinical and financial) [9, 55, 56] listed as a case
manager activity, is aimed at the sustainability of the ser-
vice or system, at most is an (administrative) responsibility
of the case manager to the service or organisation rather
than an intervention directed at the client. These difficul-
ties confirm the complexity around case management
resulting in terminological variance used. The literature
in this scoping study spanned a 25 year period (1988 to
2013). While case management to coordinate services has
been used since the late 19th century and contemporary
case management emerging since the 1960’s [57], this
scoping review confirms that over time the description
and terminological variance remains.
The terminological variance reflects the ambiguity and
confusion about roles and the interventions performed
by case managers. Specificity and replicability of case
management are essential to evaluation of effectiveness
[58]. There are complex interdependent and dependent
factors influencing what case management interventions
are done, when, with whom and in what context. A clear
understanding and consensus on the components and a
common language to describe these factors will provide
the tool for measuring outcomes, and making compari-
sons for effectiveness and quality evaluations.
The study was limited to the descriptions and terms used
in the literature to refer to the same or similar concept
including the model, theory and components. A limita-
tion in the search strategy was not including all possible
databases. Databases such as EMBASE were not searched
as it is primarily a biomedical and pharmacological data-
base and considered unlikely to host a significant body of
community-based case management literature. Search
of the database CINAHL may have revealed additional
relevant literature. Whilst other databases could have
been considered, the volume of literature from the four
databases provided more than sufficient material to use
for data extraction to the point of saturation. The exten-
sive search for grey literature added to the volume of peer
reviewed literature. However, the point of saturation was
reached after the data extraction from 79 articles retrieved
through the four databases and multiple grey literature
The search restricted to only four health conditions is
a study limitation. The trial of searches without health
Lukersmith et al: What is Case Management? A Scoping and Mapping Review Art. 2, page 7 of 13
Model and
mapped terms
Theoretical description Case management features
1. Broker
– Service broker
– Managed care
Medical case manage-
– Generalist
[9, 25–29]*
An impartial organizational or service focused approach
to connect a patient to needed services and to coordinate
between different service providers, with an emphasis on a
network of providers thereby containing costs by prevent-
ing inappropriate access and use of services
Case managers attempt to assist
clients to identify their needs and
broker services and supports. Con-
tact is limited.
2. Clinical
– Rehabilitation
Direct care
[28, 30–42]
Involves clinical, collaborative, strategic and communica-
tion roles with patient and key stakeholders (e.g. provid-
ers, payers, employers): establishes comprehensive case
management goals and objectives, interventions, and
outcomes including specified timeframes; provides clinical
interventions and brokers other clinical services; aims to
assist, facilitate, monitor and resolve client issues using
clinical skills, clinical services and community resources;
may involve adjusting the therapeutic regimen or com-
municate the need for adjustment to other providers.
The individual goals and needs of the client dictate the
response and services. In the rehabilitation model this aim
is to restore functional ability prior to the injury or illness;
case management is extended to include identifying and
assessing client skill deficits, barriers to achievement of
personal goals, teach skills, provide support and responsi-
bility for the continuity of care and coordinating services
including in times of crisis.
Contact can be brief, or an episode of
planned activity over 2–3 years.
3. Chronic care
– Long term
– Integrated care
[9, 43–47]
More system wide integrated care but tailored to the
individual e.g. in primary practice working with a multi-
disciplinary team and utilizing system supports. Provides
proactive support by the team; and recognizes that quality
care is predicated on productive interactions between cli-
ents, families and caregivers, providers ; case managers are
providers with specific system supports (e.g., protocols),
structured relationships with specialist expertise for con-
sultation, support and integration; typically have strong
links to the primary care provider to support ongoing
coordinated and integrated care with follow-up; condition
neutral and is applicable across conditions and risk factors
Longer term involvement with a
focus on the integration of care and
4. Strengths based
[9, 27, 28, 30, 38, 39,
41, 48–53]
Based on the premise of the client using their own
strengths, resilience, interests, potentials, abilities and
knowledge to lead to recovery rather than on their limits
(deficits); adopts an ecological perspective that recognizes
the importance of people’s environments (context), the
individual’s resilience; emphasises the importance of the
relationship with the case manager, to support and enable
clients to develop skills
5. Assertive
Intensive case manage-
– Recovery
Intensive comprehen-
sive care
[5, 29, 53]
Assertive case management focuses on recovery rather
than cure of the health condition (e.g., mental health).
It involves; a team providing all necessary treatment and
care (at home or work) in their natural environment rather
than involving other services; aims to reduce hospitaliza-
tions: and purposively outreaches to clients to support
their opportunities for choice and living a meaningful
and satisfying life as a member of a community. Intensive
case management addresses the social and health needs of
people, is intensive and long term with an individual case
Assertive: Clients are shared by a
team to provide services including
outreach, direct services such as
counselling, skill development, fam-
ily consultation and support, crisis
intervention. Time of involvement is
Intensive: small case load which are
not shared across the team.
Intensive comprehensive care: combi-
nation of assertive and intensive
Table 2: Mapped models of case management, and related names, theoretical description and case management
*refer to Appendix 2 for details of the articles in scoping study.
Lukersmith et al: What is Case Management? A Scoping and Mapping ReviewArt. 2, page 8 of 13
Mapped terms
1. Case finding To identify patients not in
contact with services
– Assertive outreach
– Detection of patients
– Patient identification/outreach
– Access
– Outreach
2. Establishing
Focusing on the connection
developed between the case
manager and client
Establishing alliance and col-
laboration with the patient
– Establish and provide a one-to-one relationship
– Initial phase
– Engagement
– Building on the relationship (including with other providers)
– Establishing accountability
– Establish responsibilities
– Negotiate responsibility
– Establish therapeutic alliance
– Establish long term collaborative and human relationship
3. Assessment Comprehensive understand-
ing of the needs, capabilities
and available resources and
community services
– Need identification
– Intake
– Perform social diagnosis
– Assess client and family
– Interview
Assessment of needs (e.g. social support, levels of care, readiness and
willingness for services, living situation, financial resources, access,
barriers, home evaluation, need for referral
– Community assessment
– Gather information
– Use comprehensive assessment instruments
– Identify strengths and obstacles to attainment of goals
– Cognitive and behavioural assessment
Identify present achievements, interests, resources, interests and
– Document and communicate needs
– Document aims and objectives
– Estimate level of case management support required
– Screening for co-morbid conditions
– Determine decision making capacity
4. Planning Development of plan with
client input including setting
goals, actions steps towards
achievement of goals and
selection of resources
– Gatekeeper of funds
– Discharge planning
– Decision making
– Resource identification
– Setting goals with client
– Goal setting
– Design and implementation of care packages
– “Moving forward”
– Design of an individualized care plan
– Determine comparative costs of alternate plan options
– Review relapse prevention options
– Plan for disengagement of case management
5. Navigation Facilitate safe and effective
connections to services across
– Anticipate, identify barriers
– Help remove barriers to holistic care
6. Provision of care Supply care directly or be
delegation (relevant to
qualifications and experience
of case manager)
– Crisis intervention
– Patient interventions
– Supportive and formal therapeutic interventions
– Therapy
– Skills training
– Patient interventions
– Group work
– Medication management
– Symptom monitoring
Lukersmith et al: What is Case Management? A Scoping and Mapping Review Art. 2, page 9 of 13
Mapped terms
7. Implementation Broker and implement the
best package and arrange or
purchase services on behalf
of the client
– Care arranging
– Service implementation
– Clinical management
– Communication
– Arrange and activate services
– Develop social networks
– Locating and coordinating services
– Perform a cost-benefit analysis
Identify formal and informal community resources and support
– Collect and analyse data
– Plan for clients transition along the continuum of care
8. Coordination Navigating the system of pro-
viders and resources needed,
referral, facilitate multi-
disciplinary collaboration,
to ensure and advocate with
other agencies for the appro-
priate use of resources and
supports to client, including
their purchase of the services
– Continuity
– Linking
– Linking to needed services
– agency liaison
– Environmental interventions
– Resource management
– Liaison
– Facilitation
– Interagency coordination
– Resource acquisition
– Facilitate transitions
– Educate and facilitate
– Referral
– Negotiate
– Facilitate patient access
– Advocate with providers
– Consultation with stakeholders
9. Monitoring – Proactive support
– Monitoring service delivery
– Monitor outcomes
– Follow-up
– Tracking clients
– Maintain communication with stakeholders
– Monitoring evaluation or reassessment
– Maintenance/follow up
– “Pushing/pulling and letting go”
– Manage
10. Evaluation Determine the clients
progress toward established
goals and outcomes and the
effectiveness of care
Monitor outcomes and quality of care
– Reassessment
– Evaluate effectiveness including timeliness
– Document client response
– Evaluate availability of services needed
– Determine. Prepare and communicate when case management services
no longer required
– Collect and analyse outcome data
11. Feedback General
– Case consultation
– Reports to treating providers
– Maintain privacy and confidentiality
– Regular meetings with treatment team to review goals and progress
– Listen to stakeholders, collect information objectively
12. Education/
Information and assistance
to (e.g. client, family other
service providers, workplace
etc) to assist understanding
of e.g. Health condition ,
Support services
– Providing information
– Educate about early signs and symptoms
– Assistance with applications, appropriate documents,
Lukersmith et al: What is Case Management? A Scoping and Mapping ReviewArt. 2, page 10 of 13
conditions limits produced in excess of 10,000 hits on
Medline alone. For pragmatic reasons, the search strategy
was subsequently limited to include four health condi-
tions. Those selected by the authors were known to have
community-based case managers involved in health, social
care and education sectors.
The study did not undertake quality analysis of the research
papers. It is recognised that this meant that equal weight
was given to all papers and grey literature, which we con-
sider was justified given the purpose of the scoping study to
examine descriptors of case management components and
context not efficacy of case management. There can also be
concerns about potential bias in scoping reviews related to
the reviewers own interests, lack of training and limited view
due to discipline or language [59]. Others suggest that there
is a ‘trade off’ of potential source of bias in perception and
interpretation of a subject and conversely that subject matter
experts are necessary [59–62]. In this instance, considering
the complexity in case management, the three researchers
background and expert knowledge was considered an advan-
tage to the scoping and conceptual mapping.
The scoping review used five of the six steps in the
framework articulated by Arskey et al [17] and extended
by Levac [16]. The 6th step it the Arskey/Levac methodol-
ogy is consultation with a broader group of experts and
stakeholders to discuss the findings. This step was not
performed as part of the scoping review but did occur in
a subsequent step of the larger study to develop a taxon-
omy on case management. In the larger study, a nominal
group of case management experts extensively discussed
the results of the scoping review to develop the Beta 2 ver-
sion of the case management taxonomy [23].
Case management with all its different names, variations and
contexts continues to support the coordination, integration
and management of health and social care in many different
contexts for different health conditions. The results of this
scoping and mapping study confirms the significant termi-
nological variance which produces role confusion, ambigu-
ity and hinders comparability across different health. There
is an urgent need for an internationally agreed taxonomy for
Mapped terms
13. Advocacy Advocate for the client, best
practice and the payer in line
with client’s best interests
– Advocacy for social service programs, during hospitalisation etc
– Advocate for more community-based services
– Community advocacy
– Obtaining financial assistance for the client
Intermittent function, affirmative, assertive approach to assisting client
in receiving amenities or services that are being withheld unfairly.
– Aiming to have gap/need filled
– Assist clients to become autonomous and informed decision-makers
14. Supportive coun-
Provide practical and emo-
tional support, encourage-
ment to facilitate knowledge,
coping, adjustment and
– Encouragement/support
– Provision of problem solving support
– Confrontation
– Counselling
– Individual, family or social support
– Provision of emotional support
– Conflict resolution
– Provide practical and emotional support
15. Administration Complete administrative
– Agency and other meetings
– Complete paperwork
– Treatment planning
– Recording, report writing
– Audits
– Gathering statistics
16. Discharge/
Determining and planning
for the appropriate time to
discontinue case manage-
ment including facilitating
client independence and
knowledge to self-manage
condition and care needs
– Planning case closure
– Case closure
17. Community ser-
vice development
Support local community
to take collective action to
develop new, adapt or grow
services or generate solutions
to common local problems
– Identify gaps
– Use of statistics
– Prepare funding submission
– Create options with generic services
Identify and act on service gaps and overlaps at the client, community
and population levels.
Table 3: Examples of the terms in the literature mapped to component heading.
Lukersmith et al: What is Case Management? A Scoping and Mapping Review Art. 2, page 11 of 13
the coordination, navigation and management of care. The
result of this scoping and mapping review was the first of
four steps to develop the case management taxonomy final-
ised in 2015. [23].
Future research
The results from this scoping and mapping study is part of
a larger study to develop a knowledge map and common
language, the case management taxonomy which has an
intervention tree, service tree and glossary [23].
Supplementary Files
The supplementary files for this article can be found as
Supplementary File 1: Appendix 1. http://dx.doi.
Supplementary File 2: Appendix 2. http://dx.doi.
Supplementary File 3: Appendix 3. http://dx.doi.
Helen Killaspy, Professor of Rehabilitation Psychiatry, Uni-
versity College London, UK.
Two anonymous reviewers.
Competing Interests
The authors declare that they have no competing interests.
Author contribution
All authors contributed to the research and manuscript.
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How to cite this article: Lukersmith, S, Millington, M and Salvador-Carulla, L 2016 What is Case Management? A Scoping and
Mapping Review.
International Journal of Integrated Care
, 16(4): 2, pp. 1–13, DOI:
Submitted: 04 May 2016 Accepted: 26 September 2016 Published: 19 October 2016
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... The literature surrounding BICM is relatively scarce, particularly from a UK perspective, and therefore little is known about its effectiveness or a definitive understanding of what the role should entail (Lukersmith, Millington and Salvador-Carulla, 2016). However, the work of Lukersmith et al (2016) highlights the need for an integrative approach to case management across services that is key to the model of case management used within brain injury. ...
... The literature surrounding BICM is relatively scarce, particularly from a UK perspective, and therefore little is known about its effectiveness or a definitive understanding of what the role should entail (Lukersmith, Millington and Salvador-Carulla, 2016). However, the work of Lukersmith et al (2016) highlights the need for an integrative approach to case management across services that is key to the model of case management used within brain injury. The review also identified the key role brain injury case management can play in supporting statutory services. ...
... The BICM process is, in reality, iterative and subject to change as the intervention proceeds (Clark- Wilson and Holloway, 2015). Prioritisation of efforts and goals is by necessity a joint and shared effort, the role is relationship based (Lukersmith et al., 2016). Participants commented that their role included the coordination, implementation and maintenance of an appropriate support system tailored to each client's needs. ...
Full-text available
Context: The Acquired Brain Injury (ABI) literature highlights various factors that can prevent successful community rehabilitation and hinder good long-term outcomes. Brain injury case management is a service model with the potential to overcome these barriers within rehabilitation and longer-term care and support, but there is minimal research surrounding the effectiveness of case management in ABI. Objectives: This study aims to gain a better understanding of outcomes in brain injury case management and what facilitates good outcomes when working with clients. Methods: Using a mixed qualitative approach using both conventional content analysis and thematic analysis, 28 Brain Injury Case Managers completed an online qualitative questionnaire about what constitutes a good outcome in brain injury case management. Of these, five took part in a follow-up interview. Findings: The analysis identified four themes related to brain injury case management outcomes; 1) A client-centred approach to outcome, 2) the role of the Brain Injury Case Manager, 3) Monitoring outcome in case management, and 4) Issues of funding. Limitations: Response rate to the survey and interviews was low due to recruiting during the COVID-19 pandemic. The study only included Brain Injury case mangers and future studies should consider including clients and family members perspectives. Outcome and brain injury case management Implications: This study identified that brain injury case management is a holistic approach to rehabilitation and case coordination that requires further attention. Appropriate holistic measures of quality of life and outcome need to be developed to support the evidence-base for case management.
... The lifetime cost of severe TBI is an estimated $4.5 Table 1. The interdependent and dependent components of case management [18,20]. ...
... In seeking to quantify the type and amount of vocational case manager interventions, two key factors were thought to influence service actions, provider type and employment pathway [18]. First, providers appointed to partnerships included both government and insurance-funded service providers, with some differences between the two service models. ...
... As previous research has identified, a common problem in the 'black box' of case management and other complex interventions is defining and describing the dependent and independent components, measuring them for analysis and quality appraisal [14,18,25,34]. The CMTaxonomy was developed as a tool to support analysis of case management, adopting the definition of 'action' as consistent with the international ontological framework of the World Health Organization International Classification of Health Interventions (ICHI) [35]. ...
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Little is known about service actions delivered in the complex intervention of vocational rehabilitation (VR) for people with severe acquired brain injury (ABI). Scale-up of the Vocational Intervention Program (VIP) across the 12 Community teams of the NSW Brain Injury Rehabilitation Program provided an opportunity to analyse the intensity and profile of actions delivered in providing VR programs. Seventy-two participants with severe TBI were supported in returning to either pre-injury employment (FastTrack, FT, n = 27) or new employment (NewTrack, NT, n = 50), delivered by two types of VR providers (Disability Employment Service DES; private providers). VR providers documented their service actions in hours and minutes, using the Case Management Taxonomy, adapted to VR. The NT pathway required significantly higher levels of intervention in comparison to FT (25 h, five minutes vs. 35 h, 30 min, p = 0.048, W = 446). Case coordination was the most frequent service action overall (41.7% of total time for FT, 42.3% for NT). DES providers recorded significantly greater amounts of time undertaking engagement, assessment and planning, and emotional/motivational support actions compared to private providers. Overall duration of the programs were a median of 46 weeks (NT) and 36 weeks (FT), respectively. This study helps illuminate the profile of VR interventions for people with severe TBI.
... Care coordination interventions appeared necessary in the context of complex medical pathways involving many providers in the management [71,72] of people with multiple comorbidities [72] (including chronic diseases [73][74][75][76][77] ) and having frequent use of the health system [78] . The retrieved care coordination interventions most frequently concerned the following diseases: cancer at different points in management ( i.e. screening, announcement, post-treatment phase [79] and link between primary care and oncology services [80,81] ); after a cardiovascular accident [75,[82][83][84] ; in the context of dementia [85][86][87] , diabetes [75,82,88] , asthma [82,89] , rheumatoid arthritis [ [75,82] , or chronic obstructive pulmonary disease [75] ; after a spinal cord injury [90] ; and in the context of mental health and addictions [82,91,92] . ...
... -Care implementation activities (such as monitoring delivery services, executing care plans and implementing care packages ) and activities related to medical treatment such as ( prescription of medication, reviewing drugs and medication conciliation ), which were not specific to care coordination functions, but were focused on provision of care. -Outdated terminologies found in the literature, such as ' Advocacy, advocate for the patient, or speak on behalf of families in an advocacy manner' [ [70] , [74] , [92] , [96] , [102] , [114] , [118] ], 'doctorpatient relationship' and 'patient engagement' (a preferred phrase was ' establish liaison or collaboration with the patient '). -Activities not strictly specific to care coordination interventions such as activities related to specific categories of professionals (such as triage, transportation assistance and making travel arrangements ) or activities related to health care providers (such as psychological support ). ...
... Based on their personal experience, those experts selected more specific care coordination activities by removing activities related more to other professions than to coordination. For example, 'emotional support' [74] was retrieved from the literature search, but was excluded from the reference framework because care coordination was presumed to refer patients to dedicated supportive care professionals. ...
Background Because of the limits in conceptualisation of care coordination linked to the large array of care coordination models and definitions available, a care coordination framework is needed with a particular focus on the micro level. Objective To develop an evidence-based reference framework for person-centred care coordination interventions based on international validated definitions. Methods This two-step mixed-methods study included first, a scoping review of reviews focus on the impact of care coordination interventions and then, a nominal group technique. The scoping review aimed at identifying the components of the four dimensions of the framework (contexts, activities, actors and tools, and effects). The nominal group technique was to select the relevant components of the dimension ‘activities’ of the reference framework. Results The scoping review selected 52 articles from the 1,407 retrieved at first. The nominal group selected the 66 most relevant activities from the 159 retrieved in the literature (28 activities of care organisation, 24 activities of care, and 14 activities of facilitation). Conclusion This operational framework focused on care coordination at the micro level, is a useful and innovative tool, applicable in any clinical condition, and in any health care system for describing, implementing and evaluating care coordination programmes.
... Systematic mapping review (SMR) is among the fourteen reviews system that have been used in a significant number of studies by Grant and Booth (2009). According to Maisiri and Van Dyk (2020), this systematic mapping reviews is to identify research gaps in existing literature (Fernandez et al., 2015;Gordon et al., 2012;O'Cathain et al., 2013;McDaniel-Peters & Wood, 2017;Brett et al., 2011;Booker et al., 2015;Lukersmith et al., 2016). It is a review method commonly used when a focused area of inquiry is in early research development (McDaniel-Peters & Wood, 2017;Maisiri & Van Dyk, 2020). ...
... The literature search was conducted on three different sources which are Scopus, Web of Science, and Google Scholars online databases and included the search of grey literature on key consulting organisation websites. This is also by expanding the data source by a dedicated search of reference lists (Maisiri & Van Dyk, 2020;Lukersmith et al., 2016). Table 2 was designed to identify and categorise the keywords which represent factors concerning teaching with technology 4.0 It is an instructional approach that accommodates the diversity of students (abilities, interest, level of thinking, personalities, demographic background) by adopting specific teaching strategies, invoking a variety in learning strategies, assessing individual needs, and finally pursuing optimal learning outcomes (Suprayogi & Valcke, 2016;Suprayogi et al., 2017). ...
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... Briggs et al. [45] employed an Infant Toddler Specialist case manager who was a licensed bilingual early childhood psychiatrist. Wasnick et al. [42] employed a broker model of case management, whereby the broker supported the family to identify their needs and brokered supportive services in one or two contacts [46]. This model assumed that a caregiver knowledge of service options and access pathways would increase service use. ...
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This review assesses the effectiveness of integrated primary health and social care hubs on mental health outcomes for children experiencing adversity and describes common integration dimensions of effective hubs. PubMed, OVID Medline and PyschINFO databases were systematically searched for relevant articles between 2006-2020 that met the inclusion criteria: (i) interventional studies, (ii) an integrated approach to mental health within a primary health care setting, (iii) validated measures of child mental health outcomes, and (iv) in English language. Of 5961 retrieved references, four studies involving children aged 0-12 years experiencing one or more adversities were included. Most children were male (mean: 60.5%), and Hispanic or African American (82.5%). Three studies with low-moderate risk of bias reported improvements in mental health outcomes for children experiencing adversity receiving integrated care. The only RCT in this review did not show significant improvements. The most common dimensions of effective integrated hubs based on the Rainbow Model of Integrated Care were clinical integration (including case management, patient-centred care, patient education, and continuity of care), professional integration, and organisational integration including co-location. These results suggest hubs incorporating effective integration dimensions could improve mental health outcomes for children experiencing adversity; however, further robust studies are required. Registered with Prospero: CRD42020206015.
... It facilitates the horizontal integration of care for SMIs across health and social services. Case managers will try to understand the client's needs, develop a care plan, connect them to the services they need, and assist patients in maintaining regular engagement with psychiatric services [13]. The case manager may be a registered psychiatric nurse, a social worker, or an occupational therapist [14]. ...
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Purpose of Review We reviewed the existing and recent community models of care in schizophrenia. We examine characteristics, recent updates, evidence, cost-effectiveness, and patients’ acceptance for existing and new community-based care models in high-income (HI) and low- and middle-income (LAMI) countries. Recent Findings Assertive Community Treatment (ACT), Intensive Case Management (ICM), and Crisis Intervention are cost-effective interventions for schizophrenia and time tested in the last few decades in HI countries. The growing evidence suggests that tailor-made ACTs and ICM can effectively reduce substance use, homelessness, and criminal activity in persons with schizophrenia who live in the community. Similarly, in LAMI Countries, a few community-based care models for schizophrenia have been developed and tested based on community-based rehabilitation principles. Summary The modality of a community model of care and interventions for a person with schizophrenia should be chosen based on the person’s co-existing psychosocial difficulties and challenges such as homelessness, criminal behaviour, and substance use.
Unter dem Konzept des Gatekeepingsgatekeeping wird verstanden, dass jede Behandlungsepisode mit Ausnahme von Notfällen und einigen vorab definierten Leistungsbereichen mit einem Besuch bei einem individuell bestimmten Allgemeinarzt beginnt. Entsprechend wird auch von Hausarztmodellen gesprochen. Der Versicherte delegiert die Entscheidung, ob die benötigten Leistungen von diesem selbst erbracht werden, ob ein Facharzt konsultiert werden soll oder gar ein Krankenhausaufenthalt notwendig ist, an seinen Gatekeeper. Sämtliche Leistungen werden somit von diesem erbracht oder zumindest veranlasst.
Domestic violence is an important public health problem due to its magnitude, frequency and repercussions for the health of individuals, families, groups and communities. It is a multifactorial phenomenon defined by the World Health Organization (WHO) (Taft et al., 2012) Introduction (Nurses play an important role in health teams, both in recognizing the situation of violence and in responding to the provision of care to victims and their families, for which Leadership is an extraordinarily necessary and required skill for nurses to influence their teams to provide nursing care that responds to users' expectations (Amestoy et al., 2014); Goals Identify the scientific evidence on the intervention of the case manager nurse in the promotion of the prevention of Domestic Violence; Methods Integrative Literature Review of studies indexed in the MEDLINE databases (PubMed / Medline), CINAHL, Cochrane, and in other databases of the EBSCOHost platform (LILACS, SCOPUS and Web of Science), and also a search in the bibliographic references of the articles selected. The selected studies are for the period between 2010 and 2020; Results Eleven articles were included on the implementation of Domestic Violence detection and prevention programs with results for victims, for nurses, for nurse managers and for the efficiency of organizations, in Primary Health Care and in Hospitals and Conclusions. The Implementation of Case Management Models improves the response to victims of violence, with consequences on the quality of care provided, with an increase in prevention of health results. No studies were found relating the nurse who is the case manager for domestic violence in Primary Health Care.
Purpose: The purpose of this paper is to review Safeguarding Adult Reviews (SARs) pertaining to individuals with Acquired Brain Injury (ABI) since 2014. This extended literature review also explores the lessons and recommendations from these reviews in relation to social work practice within the UK. Design/methodology/approach: The literature review reported and discussed findings across reviews and then used a thematic analysis to synthesise the findings and recommendations from the SARs reviews. Findings: The authors identified four main themes; 1) a lack of awareness of the needs of those with ABI and their families, and around the symptoms and nuances of brain injury, particularly executive impairment and mental capacity, among social workers, 2) poor interdisciplinarity led to a lack of shared communication and decision-making with professionals with such knowledge, 3) a poor understanding of aspects of the mental capacity legislation, particularly surrounding unwise decisions, led to inappropriate or absent mental capacity assessments and 4) a lack of professional curiosity led to a lack of action where intervention or assessment was required. Originality: While there have been extensive reviews conducted on SARs, this is the only review that has focused solely on ABI. Research Implications: The review identifies significant shortcomings in social work practice, education and training within the UK with regards to ABI. Practice Implications: The paper provides recommendations to current social work practice and highlighted the need for significant improvements in pre-qualification and post-qualification training and supervision of social workers.
Objective: Precision medicine is revolutionizing cancer treatment. However, there has been limited investigation of barriers patients endure to access precision cancer medicine. This study aims to report the experiences of underserved patient populations with limited access to genomic testing, clinical trials, and precision cancer treatment. Methods: A mixed-method study was employed to quantitatively evaluate patients (N=300) seeking precision cancer medicine between January 2014- August 2017. Qualitatively, we conducted semi-structured interviews with eight case managers who navigate the health care and health insurance systems to provide patients with access to precision cancer medicine care. All interviews were analyzed to identify themes. Results: Within our patient cohort, 69% were diagnosed in stage I of cancer disease. Overall, 27 patients (9%) were denied treatment as a final outcome of their case due to insurance denials, 35 patients (12%) died before gaining access to precision cancer medicine, and 6 patients (2%) received precision cancer medicine through clinical trials. Four broad thematic areas emerged from the qualitative analysis: 1) lack of patient, provider and insurer knowledge of precision cancer medicine; 2) barriers to clinical trial participation; 3) lack of patient health literacy; and 4) barriers to timely access to care. Conclusion: Our combined analyses suggest that both system-level and patient-level barriers limit patient access to precision cancer medicine options. Additionally, we found that these barriers may exist not only for traditionally underserved patients, but also for resourced and insured patients trying to access precision cancer medicine.
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Background: Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. Objective: To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. Methods: The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. Results: The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. Conclusions: The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation.
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Many models and frameworks are currently used to classify or describe knowledge translation interventions to promote and integrate evidence into practice in healthcare. We performed a scoping review of intervention classifications in public health, clinical medicine, nursing, policy, behaviour science, improvement science and psychology research published to May 2013 by searching MEDLINE, PsycINFO, CINAHL and the grey literature. We used five stages to map the literature: identifying the research question; identifying relevant literature; study selection; charting the data; collating, summarizing, and reporting results. We identified 51 diverse classification schemes, including 23 taxonomies, 15 frameworks, 8 intervention lists, 3 models and 2 other formats. Most documents were public health based, 55% included a literature or document review, and 33% were theory based. This scoping review provides an overview of schemes used to classify interventions which can be used for evaluation, comparison and validation of existing and emerging models. The collated taxonomies can guide authors in describing interventions; adequate descriptions of interventions will advance the science of knowledge translation in healthcare.
Background: Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. Objectives: To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). Selection criteria: All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. Data collection and analysis: At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. Main results: The 2016 update included two more studies (n = 196) and more publications with additional data for four already included studies. The updated review therefore includes 7524 participants from 40 randomised controlled trials (RCTs). We found data relevant to two comparisons: ICM versus standard care, and ICM versus non-ICM. The majority of studies had a high risk of selective reporting. No studies provided data for relapse or important improvement in mental state.1. ICM versus standard careWhen ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD -0.86, 95% CI -1.37 to -0.34,low-quality evidence). Similarly, for the outcome global state, ICM reduced the number of people leaving the trial early (n = 1798, 13 RCTs, RR 0.68, 95% CI 0.58 to 0.79, low-quality evidence). For the outcome adverse events, the evidence showed that ICM may make little or no difference in reducing death by suicide (n = 1456, 9 RCTs, RR 0.68, 95% CI 0.31 to 1.51, low-quality evidence). In addition, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment due to very low-quality evidence (n = 1129, 4 RCTs, RR 0.70, 95% CI 0.49 to 1.0, very low-quality evidence).2. ICM versus non-ICMWhen ICM was compared with non-ICM for the outcome service use, there was moderate-quality evidence that ICM probably makes little or no difference in the average number of days in hospital per month (n = 2220, 21 RCTs, MD -0.08, 95% CI -0.37 to 0.21, moderate-quality evidence) or in the average number of admissions (n = 678, 1 RCT, MD -0.18, 95% CI -0.41 to 0.05, moderate-quality evidence) compared to non-ICM. Similarly, the results showed that ICM may reduce the number of participants leaving the intervention early (n = 1970, 7 RCTs, RR 0.70, 95% CI 0.52 to 0.95,low-quality evidence) and that ICM may make little or no difference in reducing death by suicide (n = 1152, 3 RCTs, RR 0.88, 95% CI 0.27 to 2.84, low-quality evidence). Finally, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment as compared to non-ICM (n = 73, 1 RCT, RR 1.46, 95% CI 0.45 to 4.74, very low-quality evidence).3. Fidelity to ACTWithin the meta-regression we found that i.) the more ICM is adherent to the ACT model, the better it is at decreasing time in hospital ('organisation fidelity' variable coefficient -0.36, 95% CI -0.66 to -0.07); and ii.) the higher the baseline hospital use in the population, the better ICM is at decreasing time in hospital ('baseline hospital use' variable coefficient -0.20, 95% CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but the 'baseline hospital use' result still significantly influences time in hospital (regression coefficient -0.18, 95% CI -0.29 to -0.07, P = 0.0027). Authors' conclusions: Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital.However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach.We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
This study assessed the level of agreement among expert's opinion of the critical ingredients of the strengths model of case management. Twenty-eight experts rated the "significance" to the model of 72 elements/behaviors thought to be important and 8 distracter elements. there were also five open-ended questions testing for opinions on agency structure, service delivery, etc. The results found an extremely high agreement among the experts on virtually all items.
Case management (CM) is one of the principal components of service delivery in mental health services. Over time, it has evolved into new models, and various meta-analytic studies have been carried out to establish its effects. Those studies have yielded non-homogeneous results, which might be related in part to the progress of case management models. Therefore, there is a need to understand the relationship between CM models and CM effects. This paper deals with this issue by reviewing and updating the literature regarding case management models and effects in order to help understand its current role and suggest how CM could be reorganized. Findings Assertive community treatment and any other case management model seem to have fused and turned into two models that differ mainly with regard to the intensity of care provided to patients. The results of the meta-analyses on the efficacy/effectiveness of case management are not homogeneous across all studies, which seems to be related to the case management model used and the strictness of the methodology followed. When the model of case management used is congruent with clinical practice, the results favor case management over standard care and show that intensive and non-intensive case management may be provided depending on the previous use of hospital resources. Application The argument suggests that case management models could be reconfigured by offering an intensive form of care based on patients’ needs.
Background: Case management by health care assistants in small primary care practices provides unclear benefit for improving depression symptoms. Objective: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving depression symptoms and process of care for patients with major depression. Design: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned. Setting: 74 small primary care practices in Germany from April 2005 to September 2007. Patients: 626 patients age 18 to 80 years with major depression. Intervention: Structured telephone interview to monitor depression symptoms and support for adherence to medication, with feedback to the family physician. Measurements: Depression symptoms at 12 months, as measured by the Patient Health Questionnaire-9 (PHQ-9); secondary outcomes were patient assessment of chronic illness care, adherence to medication, and quality of life. Results: A total of 310 patients were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control patients were assessed ; 555 patients were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control patients). Compared with control patients, intervention recipients had lower mean PHQ-9 values in depression symptoms (―1.41 [95% CI, ―2.49 to ―0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups. Limitation: Patients, health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of patients was incomplete. Conclusion: Case management provided by primary care practice― based health care assistants may reduce depression symptoms and improve process of care for patients with major depression more than usual care.