Partners for the optimal organisation of the healthcare continuum for high users of health and social services: protocol of a developmental evaluation case study design

Abstract

IntroductionCase management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the clienteles and programmes that contribute to positive impacts. The purpose of this project is thus to describe and evaluate the case management programmes of four health and social services centres in the Saguenay-Lac- Saint-Jean region of Québec, Canada, in order to inform their improvement while creating knowledge on case management that can be useful in other contexts.Methods and analysisThis research relies on a multiple embedded case study design based on a developmental evaluation approach. We will work with the case management programme for high users of hospital services of each centre. Three different units of analysis will be interwoven to obtain an in-depth understanding of each case, that is: (1) health and social services centre and local services network, (2) case management programme and (3) patients who are high users of services. Two strategies for programme evaluation (logic models and implementation analysis) will guide the mixed data collection based on qualitative and quantitative methods. This data collection will rely on: (1) individual interviews and focus groups; (2) participant observation; (3) document analysis; (4) clinical and administrative data and (5) questionnaires. Description and comparison of cases, and integration of qualitative and quantitative data will be used to guide the data analysis.Ethics and disseminationThe study protocol was approved by the Ethics Research Boards of the four health and social services centres (HSSCs) involved. Findings will be disseminated by publications in peer-reviewed journals, conferences, and policy and practice partners in local and national government.

Understanding Barriers to and Facilitators of Case Management in Primary Care: A Systematic Review and Thematic Synthesis

“…I n response to an aging global population and the corresponding increase in chronic illness, case management has emerged as a powerful innovation to better care for patients with complex needs in primary care. [1][2][3] Patients with complex needs often have multiple chronic conditions, which may be compounded by mental health comorbidities, social vulnerability, or both. 4,5 These patients consume a disproportionately high volume of health care resources, 6,7 and often experience poor care coordination and chronic illness management.…”

Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations

“…This study was developed as part of the developmental evaluation of a CMP in the Integrated University Health and Social Services Centre (hereafter called ‘hospital network”) located in the Saguenay-Lac-Saint-Jean region of the province of Québec (Canada) [ 12 ]. This hospital network is composed of six health and social services centres (hereafter called ‘hospital’), each including a hospital, community and long-term care centres, a child and youth protection centre, and a rehabilitation centre to ensure access, continuity, coordination and the quality of services intended for the population of their local territories [ 44 ].…”

“…long-term care, education, and vocational and housing services) in order to improve outcomes (clinical, satisfaction, and efficiency)” [ 10 ]. Case management programs (CMPs) are increasingly used to improve the integration of services [ 11 , 12 ]. Defined as ‘collaborative, client-driven processes for the provision of quality health and support services through the effective and efficient use of resources’ [ 13 ], their benefits for patients include the improvement of self-management skills, adherence, satisfaction, health status and quality of life.…”

The role of evaluation in iterative learning and implementation of quality of care interventions

“…Evaluations can also explore if women whose trajectories of outcomes are more favorable also live in households/communities that have greater supports. From a more developmental perspective, an evaluation could also explore how care in the facility needs to understand and incorporate the types of support systems that exist both within the household and within the community within the care process [ 57 ]. Such considerations become especially important if one considers the inequity aspects of quality of care [ 58 , 59 ].…”