Measuring case management for families with HIV

Case management has been recognized as a major way for coordinating the multiple services needs for people with HIV/AIDS. Such coordination is required because of the progressively debilitating nature of this chronic disease and the fragmented health care and social services delivery system. One of the major problems with the study of case management is the difficulty in actually measuring it. Another major limitation has been the focus almost exclusively on adult models of HIV/AIDS case management. This study was undertaken to assess the efficacy of a time study methodology to measure differences in case management activities when case managers work with families and when they work with individuals. Ten case managers from two urban hospital pediatric and adult HIV/AIDS clinics and 10 case managers from 3 community organizations participated. Case management activity was sampled using a beeper carried by case managers which signaled randomly 8 times a day over 5 consecutive days. When the signal "beeped", case managers checked off on a 1-page form the appropriate descriptor of their involvement concerning task initiation, interaction, location, type, function as well as information about client needs, HIV status, and family history. The results suggest that the Time Study methodology is a useful and valid way of measuring case management and of identifying differences in case mix, client need and background, and case management techniques when case managers work with families and with individuals.