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. 2020 Jun 1;10(6):e038241.
doi: 10.1136/bmjopen-2020-038241.

Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs

Alya Danish  1 , Maud-Christine Chouinard  2 , Kris Aubrey-Bassler  3 , Fred Burge  4 , Shelley Doucet  5 , Vivian R Ramsden  6 , Mathieu Bisson  7 , Monique Cassidy  5 , Brian Condran  4 , Mireille Lambert  8 , Carla Penney  3 , Véronique Sabourin  9 , Mike Warren  10 , Catherine Hudon  7   11
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Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs

Alya Danish et al. BMJ Open. .

Abstract

Introduction: Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3).

Methods and analysis: A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis.

Ethics and dissemination: This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.

Keywords: organisation of health services; primary care; protocols and guidelines; qualitative research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Conceptual model for the implementation analysis of a case management (CM) intervention.
See this image and copyright information in PMC

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References

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