School of Public Health, University of California, Berkeley, Berkeley, California, USA
Contra Costa Health Services, Martinez, California, USA.
BMJ Open Qual. 2022 Jun;11(2). doi: 10.1136/bmjoq-2021-001807.
Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers.
Case management program for high-risk, complex patients run by an integrated, county-based public health system.
30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March-November 2019.
The analysis intended to identify characteristics of success working with patients.
Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients' mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics.
Themes emphasise the importance of compassion for complexity in patients' lives, and success as a step-by-step process that is built over longitudinal relationships.
卫生系统正在加大力度解决健康和社会风险问题，尽管早期证据的异质性表明需要更细致地探讨此类方案如何运作以及如何全面评估方案的成功。本定性研究旨在从跨学科个案经理的角度确定大规模健康和社会需求个案管理计划的成功特征。
由综合的、基于县的公共卫生系统运行的高风险、复杂患者的个案管理计划。
30 名个案经理，通过有目的的抽样，代表他们跨学科的健康和社会工作背景。访谈于 2019 年 3 月至 11 月进行。
分析旨在确定与患者合作的成功特征。
个案经理描述了与患者合作的三个成功特征：（1）建立信任；（2）观察患者心态或主动性的变化；（3）促进稳定和独立。贯穿这些特征，个案经理强调了患者定义自己成功的重要性，这通常通过个性化、渐进的进展来体现。因此，成功的时刻通常与外部看法和运营或生产力指标形成对比。
主题强调了对患者生活复杂性的同情心的重要性，以及成功是一个逐步建立的过程，是通过长期关系建立的。
