Case Management for pluripathological chronic patients: Development and validation of a scheduled follow-up intervention in Valencia La Fe Health Department

• Published in: International journal of integrated care 2016-12, Vol.16 (6), p.131
• Main Authors: Tortajada Velert, Salvador, Faubel Cava, Raquel, Gimenez Campos, Maria Soledad, Soriano Melchor, Elisa, Donat Castello, Lucas, Bahamontes Mulió, Amparo, García Gómez, Juan Miguel, Valdivieso Martínez, Bernardo
• Format: Article
• Language: English
• Subjects: Activities of daily living; Case management; Chronic illnesses; Emergency medical care; Empowerment; Hospitals; Intervention; Patients; Telemedicine
• ISSN: 1568-4156; 1568-4156
• DOI: 10.5334/ijic.2679

Introduction: In the past few years, healthcare systems are facing a growing demand related to high prevalence of chronic diseases. Case Management (CM) programs have emerged as a new approach for the management of chronic disease focused on improving individual’s health and serving social needs. Nevertheless, there is no great scientific evidence about the impact on healthcare of using generic CM program for high-complexity chronic patients.Methodology: We evaluated a CM model based on a reengineering care process that has aligned the health care levels implied, providing the attention from a patient centred perspective and promoting the patient empowerment through education and self-care. A retrospective cohort study has been carried out using a sample of 714 adult chronic patients admitted at the Valencia-La Fe Health Department Chronic CM program between January 2012 and January 2015.Results: The results of the one-tailed matched Wilcoxon’s hypothesis test (α=5%), show statistically significant differences for the rate of unplanned admissions and for the rate of emergency room (ER) visits. The rate of admissions in Hospital at Home (HaH) did not show a significant difference. The results showed statistically significant differences for the rate of unplanned hospitalization Length of Stay (LoS) and for HaH. The results of the RR of admission show that the risk of unplanned admission decreases to a 58.4%, and the risk of visits to the ER decreases to a 73.5%. However, the HaH admission relative risk increases in 50.2%.Discussion: The positive results can be based on two facts. Firstly, the proactive character of the intervention through Primary Health scheduled intervention; and secondly, the support of the CM nurses from the Telemedicine Unit and the advanced care at home, developed by the HaH unit when needed.Self-management educational interventions have positive effects on hospital consumption, such as hospital admission. Two studies evaluated a home-based educational intervention on patients with heart failure achieving fewer emergency department visits and unplanned readmissions, improving quality of life and reducing mortality. We may expect that the induction program in our model empowers patients for self-care interventions and early identification of risk situations.Additionally, the close follow-up of patients and families by primary healthcare team could explain our results. The possibility of scheduled home visits and/or consultations perfor