Community-based case management: a model for outcome-based research for non-institutionalized elderly

Medical treatment and research has changed subsequent to a paradigm shift in fiscal management strategies for health care. The demand for greater fiscal and clinical accountability in health care has resulted in more bureaucratic control of physicians, health care providers and health care delivery. Institutional-based care has been deferred to community-based care, and outcomes-based measurement of treatment interventions are becoming the benchmark of effective care. The increase in our elderly population's numbers and longevity of life, combined with fiscal and clinical constraints, invite a potential health care delivery crisis for our noninstitutionalized elderly. Interdisciplinary programs, such as community-based case management, that promote the health and well-being of our noninstitutionalized elderly can be an effective response to this crisis. However, the need for empirical evidence of their effectiveness is essential.