Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning
Authors: Po Hui‐wen , Chu Ying‐Chien , Tsai Hui‐Chen , Chen Chung‐Yu , Chiu Yi‐Wen 
Published: November 2024

Aims and Objectives

This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow‐up resource utilisation and survival.

Background

To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long‐term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high‐quality patient care.

Design

Retrospective case–control study.

Methods

This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow‐up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results.

Patient or Public Contribution

To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research.

Results

The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group.

Conclusions

Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home.

Relevance to Clinical Practice

Identifying and addressing patient‐specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.