Table 2. Key Case Management Features for the Medicare Case Management Projects.
| Feature | Project I | Project P | Project H |
|---|---|---|---|
| Intervention Focus and Mode | Telephone intervention to provide CHF education and monitoring of treatment regimens and symptoms; referrals for support services; caregiver support | Intervention primarily through telephone contact to provide CHF/COPD education and monitoring of treatment regimens and symptoms; assistance arranging for support services; caregiver support | Telephone and in-person contact to provide assistance arranging for support services; client advocacy; condition-specific education; caregiver support |
| Assessment and Reassessment | Project-specific assessment form included CHF etiology, frequency of common CHF symptoms, lifestyle habits related to CHF control, medications, comorbid condition, ADL limitations, informal support; reassessment at each contact with set of follow-up questions | Initial assessment instrument included measures of mental status and ability to perform ADLs; secondary assessment instrument (administered to clients who “failed” initial assessment) included health status, medications, lifestyle habits, emotional status, informal support; reassessment with tools at 3, 9 and 12 months; reassessment informally at each contact | Assessment forms included measures of mental status, ability to perform ADLs and IADLs, depression, morale, medications, health status, informal support; reassessment quarterly in person |
| Case Management Planning | Plans included client goals regarding CHF education; social work referral documented need for support services | Plans included support services, cardiac rehabilitation, and therapy, as well as Medicare-covered services arranged by discharge planners and physicians | Plans included support services, medical services, and education, including services arranged by physicians and discharge planners |
| Client/Caregiver Education | Highly focused CHF education at each contact, building on educational pamphlet mailed to client just after random assignment; quarterly newsletters | Education at each contact | Education as noted in case management plan |
| Service Arranging and Monitoring | Case managers referred clients to social worker for support services; social worker contacted local AAA, with referral and followed up until services in place; also assisted with paperwork for indigent drug programs | Case managers arranged for services not ordered by physicians or discharge planners; telephone followup with providers and clients | Case managers arranged and coordinated services and followed up with providers and clients; included coordination for hospitalized clients |
| Staff Composition | 7 FTE nurse case managers, 1 case manager supervisor, 1 social worker | 4 FTE nurse case managers; project director was also case manager supervisor | 3 FTE case managers (2 nurses, 1 social worker), 1 case manager supervisor |
NOTES: Support services refers to homemaker/housekeeping, transportation to medical appointments, home-delivered meals, assistance purchasing medications. CHF is congestive heart failure. COPD is chronic obstructive pulmonary disease. ADL is activity of daily living. IADLs is instrumental activities of daily living. AAA is Area Agency on Aging. FTE is full-time-equivalent.
SOURCE: (Schore et al., 1997.)