in individuals and the family unit. The Effectiveness of Disease and Case Management for People with Diabetes A Systematic Review Susan L. Norris, MD, MPH, Phyllis J. Nichols, MPH, Carl J. Caspersen, PhD, MPH, Russell E. Glasgow, PhD, Michael M. Engelgau, MD, MSc, Leonard Jack Jr, PhD, MSc, George Isham, MD, Susan R. Snyder, PhD, Vilma G. Carande-Kulis, PhD, Sanford Garfield, PhD, Peter Briss, MD, David McCulloch, MD, and the Task Force on Community Preventative Services (Am J Prev Med 2002;22(4S):15–38) © 2002 American Journal of Preventive Medicine) Effectiveness and economic efficiency in disease and case management Developing an approach to identifying, organising, grouping, and selecting interventions for review; developing an analytic framework depicting interrelationships between interventions, populations, and outcomes; systematically searching for and retrieving evidence; assessing and summarizing the quality and strength of the body of evidence of effectiveness; translating evidence of effectiveness into recommendations; summarizing data about applicability, economic and other effects, and barriers to implementation; and identifying and summarising research gaps. Case management is effective in improving both glycaemic control and provider monitoring of glycaemic control and is effective when both delivered in conjunction with disease management and when delivered with one or more additional educational or reminder support interventions. Evidence supports the effectiveness of disease management on glycaemic control; on screening for diabetic retinopathy, foot lesions and peripheral neuropathy, and proteinuria; and on the monitoring of lipid concentrations. Case and disease management both impact positively on consumer quality and funder cost effectiveness Dementia Case Management Effectiveness On Health Care Costs And Resources Utilisation: a systematic review of randomised control trials. Review evidence of case management efficacy on care costs, hospitalisation and institutionalisation in consumers with dementia. Review of randomised control trials for community dwelling consumers, where studies provide done or more outcomes i cost analysis, hospitalisation, institutionalisation. Majority of trials displayed no economic advantages. Drawing conclusion on case management effectiveness hampered by the limited number and varying quality of studies. Of interest two studies that provided best evidence supporting case management intervention in reducing
goal attainment of blood pressure, fasting blood lipids, body mass index (BMI), and, among patients with diabetes, haemoglobin A1c (HbA1c). Repeated- measures logistic regression to analyse goal attainment and repeated measures Poisson regression to analyse service use. density lipoprotein cholesterol and HbA1c were not significant. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ1998;316doi: 10.1136/bmj.316.7141.1348(Published 2 May 1998) Cite this as:BMJ1998;316:1348 To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Randomised study with 1 year follow up. Setting: Town in northern Italy (Rovereto) Subjects: 200 older people already receiving conventional community care services. Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status. Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 (r1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v13.0% loss in controls; Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the Community.
Workforce qualifications Table 2: International workforce application and qualifications in case management/case coordination. COUNTRY TITLE/WORKFORCE COMPOSTION EDUCATION AND QUALIFICATION REQUIREMENTS WORKFORCE APPLICATION PROFESSIONAL BODIES United States Case Manager (may use other titles such as case coordinator, care navigator) Predominately nurses, social workers and or health related qualification. Managed Care Nurse Generally a minimum of an undergraduate degree in health science or social work with Case management nurse certification acquired through the American Nurses Credentialing Centre - ANCC (largest board certification body for nurses in United States) Accredited case manager (Accredited case manager certification) Registered nurse or license in practical nursing who has completed certified qualification –certified managed care nurse Registered nurses who complete an online certificate – note not a certification but a recognition of professional development Health insurer setting Health provider setting Workers compensation/employer setting Veterans Healthcare insurance setting Hospital setting Case Management Society of America Non-profit organisation –support and develop profession through educative opportunities, networking legislative advocacy, establishing standards of practice. Code of ethics. American Case Management Association - non-profit professional membership supports practice of hospital case management.
case manager where case management is required. Certification available and encouraged through university programmes in Canada in case management. Workers compensation/employer setting Veterans healthcare insurance setting management services in health and social services across Canada. This organisation supports the growth and development of case management as a strategy essential to an effective health care system. Their goal is to continue to advance the development of case management standards of practice, facilitate continuing education for professionals to develop their case management competencies and support members to excel in the practice of case management. Recent announcement by government (March 2012) to support the development of core competencies and standards of practice in recognition of the better health outcomes achieved through case management/case coordination. United Kingdom Case managers (community matrons, care navigators) Generally a registered nurse and or health related qualification (social, psychology, rehabilitation counsellor) for all areas of practice case management not a recognised professional title or pathway in the UK. Healthcare – public and private. Increasingly in consumers with chronic long term conditions Workers compensation Private insurance setting Case Management Society UK (2001). Committed to delivery of quality case management through standards of best practice. Research project underway over past year for development of educational pathway findings now available, which supports holding firstly a relevant professional qualification with a professional pathway that
includes an educational framework in case management practice. %20HT%20Report%202012.pdf Australia Case managers – differing titles dependent on area of work; rehabilitation coordinators, integrated care coordinators, personal injury case managers, return to work coordinator, rehabilitation counsellors Role determines qualification requirement, generally health or allied health undergraduate background and or experience, case management qualifications available are through government training schemes and/or university training in case management and personal injury management. New Zealand qualification in managed care citied (now in suspension). Workers compensation /injury management areas Community health settings/integrated care Insurance Case Management Society of Australia. Founded in 1996, (affiliate of the Case Management Society International) support came from health industry stakeholders. Non-profit organisation dedicated to support and development of the practice of quality case management, has produced national standards of practice, holds annual conferences, educational forums and networking opportunities. New Zealand Case Managers (differing titles dependent on area of work; care coordinators, clinical case managers) No health or health related qualification required in majority of case management positions unless role combines clinical input and support with case coordination Injury and private insurance settings Primary and secondary services Roles in areas such as aged care, mental health drug and alcohol Māori Health Settings No professional body in New Zealand. Not a recognised career pathway, case managers do access membership to Australian Case Management Society.
Polytechnic Education Polytechnic Certificates Diplomas Degrees Graduate Aoraki 33 (Central South Island) National Certificate in Mental Health (Level 4) (alcohol and drug) Diploma in Social Services (Level 5) Certificate in Life Skills. Certificate in Sports and Fitness Diploma in Sports and Fitness Certificate in Health Studies/national Certificate in Science (Level 4) Bay of Plenty 34 Te Kuratini o Poike National Certificate in Mental Health (Level 4) Diploma Sport and Recreation Bachelor of Science (biological sciences) Certificate in Healthcare Assistance Bachelor Of Nursing Certificate in Social Services (Level 4) Bachelor Sport and Recreation Bachelor of Social Work Christchurch 35 Te Wananga o Otautahi National Certificate in Mental Health (Level 4) Certificate in Pre- health Science Diploma in Enrolled Nursing National Diploma in Mental Health (support work) Bachelor of Nursing Bachelor of Social Work Certificate in Human Services Bachelor of Midwifery Graduate Cert in Nursing Practice 33 Aoraki Polytechnic: 34 Bay of Plenty Polytechnic : 35 Christchurch Polytechnic:
Eastern Institute of Technology – Hawkes Bay 36 Bachelor of Nursing Master of Nursing Certificate in Health Science Bachelor of Applied Social Sciences (social Work) Post Graduate Certificate in Health Science Certificate in Contemporary NZ Nursing Practice Postgraduate Diploma in Health Science Certificate in Social Sciences Certificate in Health Promotion Diploma in Health Promotion National Certificate in Hauora National Diploma in Mental Health National Certificate in Community Support National Certificate in Mental Health and Addiction Support Certificate in Work and Life Skills Certificate in Introduction to Social Services Manakau Institute of Technology 37 Pre-degree Nursing Diploma in Enrolled Nursing Bachelor of Nursing Certificate for Health Support Assistants Diploma in Health Promotion Bachelor of Nursing-Pacific Certificate in Community health Work National Diploma on Mental Health Bachelor of Applied Social Work Certificate in Pacific Community Health work Bachelor of Applied Social science (Counselling) Certificate of Achievement in Registered Nurse Competency to Practice Certificate in Social Services National Certificate in Mental Health Addiction and Support Preparation for Social Work 36 Eastern Institute of Technology: 37 Manaukau Institute of Technology:
Nelson/Marlborough Te Whare Wananga o te Tau Ihu o Te Waka a Maui 38 Certificate in Community Support Services Diploma in Career Guidance Bachelor of Nursing Certificate in Contemporary NZ Nursing Practice Bachelor of Applied Social Science (Counselling) Certificate in Foundation Nursing Bachelor of Applied Social Science (Social Work) Certificate in Counselling and social Work Northtec 39 Tai Tokerau Wananga Transition from nurse assistant to enrolled nurse Bachelor of Nursing Certificate in Registered nurse competence Bachelor of Applied Social Science Certificate in Mental Health and Addictions Certificate in Cognitive Behavioural Therapy National Certificate in Occupational Health and Safety (Level 3) National Certificate in Occupational Health and Safety (Coordination) (Level 4) Open Polytechnic Kuratini Tuwhera 40 National Certificate in Mental Health (Level 4) Diploma in Health and Human Behaviour Bachelor of Applied Science (Psychology) Diploma in Applied Mental Health Bachelor of Social Work 38 Nelson/Marlborough Institute of Technology: 39 Northtec 40 Open Polytechnic:
Otago Polytechinc Te Kura Matatini ki Otago 41 Disability Management in the Workplace Certified Disability management professional Or certified return to work coordinator Bachelor of Nursing Certificate in Health Bachelor of Midwifery Master Midwifery Competency Assessment programme for Registered Nurses return to workforce Post grad certificate and diploma in midwifery and short courses in midwifery practices Bachelor of Occupational Therapy (Honours) Masters of Occupational Therapy Post Grad certificate and diploma in occupational therapy Certificate in Human services Bachelor of Social Services National Certificate in Mental Health (Level 4) Southern Institute of Technology Te Whare Wananga o Murihiku 42 Certificates in Health Science (Level 3&4) Diploma Occupational Health and Safety practice Post Graduate Diploma/Certificate Health Science Certificate in pre Entry to Bachelor of Nursing Diploma of Enrolled Nursing Bachelor of Nursing National Certificate in Social Science (Level 4) National Diploma in Mental Health National Certificate in mental health (mental health support) (Level 4) Tairawhiti 43 Certificate in Health Science Bachelor of Applied Social Sciences (social Work) Post Graduate Certificate in Health Science (Cognitive Behavioural Therapy) 41 Otago Polytechnic: 42 Southern Institute of Technology: 43 Tairawhiti:
Relevant programmes / courses offered (Online distance and block learning available) Auckland University Te Whare Wananga o Tamaki Makaurau 55 Undergraduate Post Grad Cert Post Grad Diploma Masters PhD Medical and Health Sciences and School of Population Health Bachelor of Health Science Health Science: Advanced Nursing Alcohol and Drug Studies Child and Adolescent Health Mental Health Nursing Community Emergency care Forensic Psychiatry Health Informatics Social Work Sports Medicine Youth Health Pharmaceutical Science Public Health (Māori and Pacific) Palliative care Research Methods Managed Care (Currently suspended) Health Science: Advanced Nursing Alcohol and Drug Studies Child and Adolescent Health Mental Health Nursing Community Emergency care Forensic Psychiatry Health Informatics Health Management (conjunct business school) Social Work Sports Medicine Youth Health Pharmaceutical Science Public Health (Māori and Pacific) Public Health Master of Health Science Master of Audiology Master of Health Management Master of Public Health Doctor of Philosophy (PhD) all disciplines
As advised there is no formal programme of study for education in managed care/case management. However, with strong basis in health and rehabilitation academic teaching and research, expansion into managed care qualifications is a distinct possibility for this university. AUT has strong links with the community and organisations involved in disability and rehabilitation issues and as such are well placed to provide programmes in managed care; additionally case management is citied as a special interest of the Professor of Rehabilitation and there is the intention to forward this area of study within this university. Relevant programmes / courses offered (Online distance and block learning available) Auckland University of Technology Te Wananga Aronui o Tamaki Makau Rau 56 Undergraduate Post Grad Cert Post Grad Diploma Masters PhD Health Sciences Bachelor of Health Science Applied Mental Health Health Promotion Paramedicine Podiatry Psychology Midwifery Nursing Occupational Therapy Physiotherapy Bachelor of Science Bachelor of Science and Business Conjoint Bachelor of Sport and Rehabilitation Occupational Practice Advanced Nursing Practice Practice Health care Ethics Health Professional Education Leadership and Management Māori Health Mental Health Midwifery Older Adult Health and Wellness Physical Activity and Rehabilitation Occupational Practice Musculoskeletal Physiotherapy Advanced Nursing Practice Health care Ethics Health Professional Education Leadership and Management Māori Health Mental health Midwifery Older Adult Health and Wellness Physical Activity and Nutrition Rehabilitation Musculoskeletal Physiotherapy Occupational Therapy Advanced Nursing Practice Child Health Māori Health Mental Health Midwifery Physical Activity and Nutrition Doctor of Health Science Doctor of Philosophy
Postgraduate programmes Provides advanced learnings around the specific areas of rehabilitation offered through the undergraduate programme. Relevant programmes / courses offered (Online distance and block learning available) Massey Te Kunenga Ki Purehuroa 57 Undergraduate Post Grad Cert Post Grad Diploma Masters PhD Bachelor of Nursing Bachelor of Arts – Rehabilitation Studies Psychology Bachelor of Health Science - Rehabilitation Bachelor of Science Exercise and Sport Psychology Bachelor of Social Work (BSW) Bachelor of Midwifery Post Grad Cert in Health Science (Dual Diagnosis) Post grad cert in Whanau Development Post Grad Cert in arts (Social work) Diploma Rehabilitation Studies PostGrad Diploma Arts Disability Studies Post Grad Diploma in Health Studies Post Diploma in Whanau Development Post Grad Diploma in Arts (Social Work ) Master of Arts (Nursing) Master of Nursing (MN) Master of Arts-Disability Health or Rehabilitation Master of Applied Social Work ( MApplSW) Master of Social Work (MSW) PhD Nursing PhD General
inclusive of managed healthcare challenges. In this regard it is well placed to advance and extend its programmes to educate students in managed care/case management to enable them to work in settings other than injury case management 58 Relevant programmes / courses offered (Online distance and block learning offered) Otago Te Whare Wananga o Otago 58 Undergraduate Post Grad Cert Post Grad Diploma Masters PhD Bachelor of Health Science: Biomedical Sciences Medical Laboratory Science Radiation Therapy Bachelor of applied Science - Sports and Exercise Nutrition Bachelor of Social and Community Work Post Grad Cert Health Sciences Medical Technology Nursing Social Work Post grad Dip Bio Ethics and Health Law Nursing Health Management Health Sciences Medical Lab Science Nutrition Dietetics Social Work Medical Technology Sports and Exercise Medicine Masters Bio Ethics and Health Law Health Science Medical Lab Science Nursing Social Work PhD 58 Otago University:
Bachelor of Medicine and Bachelor of Surgery General Practice Occupational Medicine Primary Health Public health Rehabilitation General Practice Industrial Health Health informatics Occupational Medicine Primary Healthcare Public Health Rehabilitation Masters General Practice Medical Science Primary Healthcare Public Health MD PhD Bachelor of Physiotherapy Post Grad Cert Physiotherapy Post grad Dip Physiotherapy Master Physiotherapy PhD Bachelor of Physical Education Physical Education Physical Education PhD Bachelor of Pharmacy Prescribing Pharmacy Clinical Pharmacy Clinical Pharmacy Pharmacy PhD