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Introduction: The aim is to present the evaluation of effectiveness of case management interventions, designed from the bottom-up, which have been implemented in Belgium since 2010 to support dependent elderly people at home. This type of intervention is an integrated care process which combines prevention, evaluation, custom designed multidisciplinary care plan, coordination of services and follow-up. Mixed methods are necessary for covering the indispensable steps of the analysis of effectiveness which includes the specific description of the interventions, the identification of the target populations, the building of a control group, the tracking of pertinent indicators, and the choice of a quantitative approach bearing in mind the implementation process of the interventions. Methods: The quantitative analysis of effectiveness has been guided by the results of the implementation analysis, a qualitative approach which provides the description of essential components of the interventions. Two quantitative databases are available for the beneficiaries and the control group (not benefiting from interventions and recruited by home care organisations, thus reflecting “usual care”): (1) a prospective data collection through a validated comprehensive geriatric instrument (the interRAI Home Care instrument) including clinical variables and data related to the informal caregivers, and (2) the administrative database of the reimbursed health care consumption (routinely recorded by the health care insurance). The different types of dependency are defined through a clustering analysis grouping beneficiaries according to functional and cognitive limitations. Thereafter, each P3 beneficiary is matched by using a propensity score method with one individual of the control group having similar health characteristics and similar levels of presence of informal caregiver (without, non-cohabitant, cohabitant). Finally, the different variables for assessing effectiveness are tested between beneficiaries and the control group. Results: Case management interventions are grouped according to three criteria: (1) the feedback to a general practitioner, (2) the psychological support, and (3) the intensity of the intervention. Beneficiaries are divided into five dependency types (low limitations; important IADL limitations; important ADL and IADL limitations; significant cognitive and functional deficiencies; and people cumulating significant cognitive, functional and behavioural problems). The results are presented for each of the above subgroups in the form of a “dashboard” including the different essential indicators for the evaluation of the impact of the intervention: indicators of health care consumption (i.e. nursing care at home, visits to a medical specialist), indicators identifying the stress on the health system (i.e. unexpected hospitalisation, visits to emergency service) and clinical outcomes (i.e. functional, cognitive, and depressive status, quality of life, informal caregiver’s perceived burden). Discussion: The analysis of the data collected through the questionnaires filled out by both the care recipients and their main informal caregivers linked to the administrative database of health care consumption provides a comprehensive evaluation of the effectiveness of a complex intervention. Both clinical and use of resources outcomes are analyzed for the dyads of care recipients/informal caregivers and allow for comprehensively and accurately describing the consequences of case management interventions according to various types of situations at home. [ABSTRACT FROM AUTHOR]

Aim and background. Although many systematic reviews have been conducted over the last decade to assess the overall effectiveness of case management to achieve desirable outcomes for community-dwelling frail older persons, there is little evidence that the expected results are indeed achieved in terms of delaying unwanted institutionalisation, stabilising functional status, lower overall healthcare cost, reduce informal caregiver burden and improve quality of life. One of the reasons provided is the method of data pooling used in the meta-analyses in these reviews, by aggregating the information, despite the extreme heterogeneity of the case management interventions, i.e. components, activities and context. The aim of the systematic review was to provide one or more theories about why and how case management interventions were successful (or not) in their given contexts and for whom? Methods. A realist approach was used in order to define the mechanisms by which the case management interventions were linked to frail older persons' outcomes in a given context. Therefore, we performed firstly a qualitative scoping, in order to 'map the area' and build a tentative theoretical framework. In a second step, we conducted a systematic review in MEDLINE, EMBASE, CINAHL, ISI Web of Knowledge, PsychInfo in Spring 2013. Reference list of selected papers were hand-searched. During an iterative process of discussion with a multidisciplinary team and further diving into the extracted information from the selected articles, we build and tested a theoretical framework of successful case management. As a result of the iterative research strategy and discussions, 87 papers were included in the analysis. A first theoretical framework was proposed, guided by D'Amour's framework of collaborative professional care and linked to the outcomes of case management interventions studied. Four domains were identified: impact of the components of the interventions, impact of the characteristics of the target population, impact of the technologies or tools used and impact of the organisational strategies. Discussion. This review strategy yielded interesting and robust evidence about key components of case management interventions which can explain the success of failure of a case management intervention to achieve its goals, in a given context. [ABSTRACT FROM AUTHOR]

Background / Objective: In the international literature, case management is often found to be a valuable way of organizing home care services and providing continuity of care. However, not many studies have provided evidence that case management can be effective in delaying institutionalization of older persons. The Belgian federal government is interested in funding home care projects that attain this goal. Twenty two case management projects will be analyzed during a 4-year period to reach a policy decision. Methods: Professional caregivers are asked to fill out the comprehensive geriatric assessment interRAI Home Care (HC) and an ad-hoc economic questionnaire describing the social services use and the time of informal care Informal caregivers also fill out the Zarit Burden scale 12 items and older persons fill out the WHOQOL-8. After descriptive statistics, the study population is stratified according to impairment levels (ADL, depression and cognition). Multivariate analyses are performed to identify significant associations and the effect of case management on the delay of institutionalization. Results: The study population consists of frail older persons in 21 case management projects (n=8534, average age: 79.7 median age 81.0, 67.6% women. The total of older persons in case management projects is 5004. This population shows moderate to high ADL impairment (47% CI(0.45 - 0.48)), moderate to high cognitive problems (27% CI(0.25 - 0.27)) and daily depression symptoms (27% CI(.25 - .28). These clients will be compared to a population not receiving any case management. Conclusion: This research will show the effect of case management combined with home care interventions in order to delay institutionalization of older persons. This information can help home care providers to adapt their services into a more integrated form of care model where case management will bring different types of services together. The results will also help policy makers to decide whether case management should be funded or not. [ABSTRACT FROM AUTHOR]

Purpose/objectives: The Belgian National Institute for Health and Disability Insurance (NIHDI) is interested in delaying institutionalization of older persons. Informal caregivers play an important role in maintaining the health, well-being, functional performance and quality of life of older people living at home. The aim of this paper is to identify whether innovative projects in home care are statistically associated with decreasing the informal caregiver's perceived burden. Background/Methods: The study uses the interRAI HC instrument and a shorter version of the original 22-Zarit Burden Interview. In this ongoing study we have a population of 4346 frail older persons who have an informal caregiver and who are benefiting from innovative projects in home care. Through multivariate logistic regression researchers analyze the effect of the projects in the burden of caregivers. This method enables researchers to take into account factors such as the older person's cognitive functioning, ADL performance, depressive symptoms, as well as the informal caregivers' characteristics. Conclusions: This research will provide knowledge on perceived burden and will show whether some types of interventions may have a positive effect on decreasing the burden in giving care. This is important information for home care agencies but also useful information for policy makers at a societal level. [ABSTRACT FROM AUTHOR]