Van Mierlo Lisa D, Meiland Franka J M, Van Hout Hein P J, Dröes Rose-Marie
VU University Medical Centre, Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
BMC Geriatr. 2014 Jul 8;14:84. doi: 10.1186/1471-2318-14-84.
The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions.
A qualitative case study design was used; semi-structured interviews were conducted with 22 stakeholders on the execution and continuation phases of the implementation process. The stakeholders represented a broad range of perspectives (i.e. project leaders, case managers, health insurers, municipalities).
The independence of the case management organization in the intensive model facilitated the implementation, whereas the presence of multiple competing case management providers in the linkage model impeded the implementation. Most impeding factors were found in the linkage model and were related to the organizational structure of the dementia care network and how partners collaborate with each other in this network.
The results of this process evaluation show that the intensive case management model is easier to implement as case managers in this model tend to be more able to provide quality of care, are less impeded by competitiveness of other care organizations and are more closely connected to the expert team than case managers in the linkage model.
本过程评估的目的是深入了解两种不同病例管理模式（即联系模式和强化病例管理/联合机构模式）在提供基于社区的个性化痴呆症护理方面的促进因素和障碍。这两种新兴的痴呆症护理模式在组织和实施方式上有很大差异。为了为其他地区成功实施病例管理制定未来指南，需要深入了解不同模式实施中的促进因素和障碍。
采用定性案例研究设计；在实施过程的执行和持续阶段，对22名利益相关者进行了半结构化访谈。利益相关者代表了广泛的观点（即项目负责人、病例管理人员、健康保险公司、市政当局）。
强化模式下病例管理组织的独立性促进了实施，而联系模式中存在多个相互竞争的病例管理提供者则阻碍了实施。大多数阻碍因素出现在联系模式中，并且与痴呆症护理网络的组织结构以及合作伙伴在该网络中的协作方式有关。
本过程评估的结果表明，强化病例管理模式更易于实施，因为与联系模式中的病例管理人员相比，该模式下的病例管理人员往往更有能力提供护理质量，较少受到其他护理组织竞争的阻碍，并且与专家团队联系更紧密。
