Case management: a randomized controlled study comparing a neighborhood team and a centralized individual model

Area of Science:

• Health Services Research
• Gerontology
• Nursing Administration

Background:

• Skilled nursing patients living at home require complex care management.
• Existing case management models may not be optimal for cost-effectiveness and patient outcomes.
• Comparing different case management structures is crucial for healthcare system efficiency.

Purpose of the Study:

• To compare the cost-effectiveness of two case management models: centralized individual and neighborhood team.
• To evaluate the impact of each model on health services utilization and patient outcomes.
• To identify potential mechanisms driving observed differences in cost and utilization.

Main Methods:

• Randomized controlled study comparing centralized individual and neighborhood team case management.
• Data collected on health services costs, hospital days, home care hours, nursing home use, and mortality.
• Analysis of cost differences between 'old' and 'new' patient cohorts.

Main Results:

• The neighborhood team model resulted in 13.6% lower average annual costs compared to the individual model.
• Team cases showed 26% fewer hospital days and 17% fewer home health aide hours.
• Nursing home use was 48% higher in the team group, while second-year mortality was lower.

Conclusions:

• The neighborhood team case management model demonstrates greater cost-effectiveness for home-based skilled nursing patients.
• Reductions in hospitalizations and home care drive the cost savings of the team model.
• Further investigation into the trade-offs between home care and nursing home utilization is warranted.