Implementing case management in New York State's partnerships for publicly funded breast cancer screening

Abstract

Introduction: This research aimed to explore differences in the implementation of case management among local breast cancer screening partnerships in New York State after changes in federal public policy in 1998 and to achieve a better understanding of case management in a new and distinct practice setting. Capacity and willingness to implement change were theorized to explain local differences in implementation. Local breast cancer screening programs that received federal funding through the New York State Department of Health were invited to participate in the study.

Methods: A mail survey was administered to the directors of New York's 53 local breast cancer screening partnerships in 2003. The survey included questions about willingness and capacity to implement case management and a scale to assess case management program philosophy. Factor analysis and correlations were used to compare willingness and capacity with differences in implementation.

Results: Two common factors--task focus and self-identity focus--were identified as factors that differentiated case management programs. Task-focus partnerships undertook a broader range of tasks but were less likely to report autonomy in making program changes. Self-identity partnerships were less likely to report difficulties with other agencies and scored highly on innovation, involvement in work, and interest in client service. Having a nurse as the case manager, being aware of the standards of case management, and providing health education were associated with both task focus and self-identity focus.

Conclusion: The study identified distinct styles of implementation. These styles have implications for the breadth of services provided, such as whether client-level services only are offered. Interagency coordination was facilitated in partnerships with comprehensive case management.

Figure 1

Conceptual model for study on case management among 53 partnerships providing breast cancer screening services in New York. The study focuses on the relationship between willingness (local decisional outcome) and capacity (local capacity) to implement case management and actual local implementation.