Hudon Catherine, Chouinard Maud-Christine, Lambert Mireille, Diadiou Fatoumata, Bouliane Danielle, Beaudin Jérémie
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Centre de recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
BMJ Open. 2017 Oct 22;7(10):e017762. doi: 10.1136/bmjopen-2017-017762.
The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness.
Thematic analysis review of CM studies.
We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level.
Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration.
CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts.
本文旨在确定在有效性实证研究中发现的医疗服务频繁使用者案例管理（CM）干预措施的关键因素。
CM研究的主题分析综述。
我们基于之前发表的一篇综述进行研究，该综述旨在报告CM干预措施对医疗服务频繁使用者的有效性，使用了涵盖2004年1月至2015年12月期间的Medline、Scopus和CINAHL数据库，后更新至2017年7月，关键词为“CM”和“频繁使用”。我们提取了成功（n = 7）和不成功（n = 6）的CM干预措施的因素，并进行了混合主题分析以综合研究结果。使用肖多伊尔的健康创新实施框架将结果组织成四个广泛的因素层次：（1）环境/组织层面，（2）从业者层面，（3）患者层面和（4）项目层面。
与医疗服务提供者和社区服务资源的接触及紧密合作关系是成功的CM干预措施的关键因素，这些干预措施应针对需求最大的患者，并促进与医疗团队的频繁接触。个案管理员的选拔和培训也是促进患者参与CM的重要因素。护理协调、自我管理支持和护理导航协助是关键的CM活动。不成功的CM干预措施报告的主要问题是病例发现问题或缺乏护理整合。
针对医疗服务频繁使用者的CM干预措施应确保有足够的病例发现流程、对个案管理员进行严格选拔和培训、干预措施有足够的强度，以及所有合作伙伴之间良好的护理整合。其他研究可以进一步评估背景因素对干预效果的影响。
