Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 25;8(11):e026433.
doi: 10.1136/bmjopen-2018-026433.

Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol

Catherine Hudon  1 , Maud-Christine Chouinard  2 , Kris Aubrey-Bassler  3 , Frederick Burge  4 , Shelley Doucet  5 , Vivian R Ramsden  6 , Magaly Brodeur  1 , Paula L Bush  7 , Yves Couturier  8 , Marie-France Dubois  9 , Line Guénette  10 , France Légare  11 , Paul Morin  8 , Thomas G Poder  1   12 , Marie-Ève Poitras  2 , Pasquale Roberge  1 , Ruta Valaitis  13 , Shirley Bighead  14 , Cameron Campbell  15 , Martine Couture  16 , Breanna Davis  6 , Élaine Deschenes  17 , Lynn Edwards  18 , Sarah Gander  19 , Gilles Gauthier  20 , Patricia Gauthier  21 , Richard J Gibson  18 , Julie Godbout  16 , Geneviève Landry  22 , Christine Longjohn  14 , Norma Rabbitskin  14 , Denis A Roy  23 , Judy Roy  24 , Véronique Sabourin  20 , Tara Sampalli  18 , Amanda Saulnier  24 , Claude Spence  20 , Jennifer Splane  25 , Mike Warren  26 , Joanne Young  27 , Pierre Pluye  7
Affiliations

Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol

Catherine Hudon et al. BMJ Open. .

Abstract

Introduction: Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada.

Methods and analysis: We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method.

Ethics and dissemination: This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.

Keywords: organisation of health services; primary care; quality in health care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Bodenheimer T, Berry-Millett R. Follow the money--controlling expenditures by improving care for patients needing costly services. N Engl J Med 2009;361:1521–3. 10.1056/NEJMp0907185 - DOI - PubMed
    1. Department of Health. Caring for people with long term conditions: An education framework for community matrons and case managers UK: Department of Health - Long term conditions team; 2006. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.g... (accessed 22 Nov 2017).
    1. Wodchis W. Health Links and Beyond: The Long and Winding Road to Person-Centred Care; 2013. Ontario, Canada: High cost users: driving value with a patient-centered health system, 2012. www.northwestlhin.on.ca/./~/./nw/./High%20Cost%20Users.pdf.
    1. Commission de la réforme des services publics de l’Ontario. Des services publics pour la population ontarienne: cap sur la viabilité et l’excellence Ottawa: Gouvernement de l’Ontario; 2012. http://www.fin.gov.on.ca/fr/reformcommission/chapters/report.pdf (accessed 17 Nov 2017).
    1. Doupe MB, Palatnick W, Day S, et al. . Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med 2012;60:24–32. 10.1016/j.annemergmed.2011.11.036 - DOI - PubMed

MeSH terms