Barriers to Effective Case Management for Disabled Patients on Hemodialysis

The present study examined the performance level and its related factors on the process of case management for disabled patients on hemodialysis. Case management performance was evaluated at three stages: patient assessment, making a care plan, and monitoring/evaluation. Candidates for targeting the factors relating to performance included four dimensions: nursing care level, physical malfunction, cognitive malfunction, and barriers to service were used as patient factors; the period of case management for the patient and the knowledge of dialysis emerged as case manager factors; work load was included as an organizational factor; and community resources for these services and communication with surrounding persons were included as system factors. Self-administrated questionnaires were collected from 391 case managers of patients with hemodialysis certified long-term insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. Case managers were asked questions about their management of each individual case. The results indicate, for example, that poor knowledge of dialysis is significantly related to poor patient assessment, inadequate development of a care plan, and lower levels of monitoring/evaluation. In addition, work overload and diabetic nephropathy as the primary kidney disease were also found to be significantly related to poor patient assessment. Increasing the opportunity for case managers to learn about dialysis may be needed for better case management performance in respect of the hemodialysis of disabled patients.