Thesis (Ph. D.)--University of Washington, 2000. / Includes bibliographical references (leaves 100-121).

Background: Health systems internationally face a common set of challenges: ageing populations, increasing numbers of patients suffering from multiple long-term conditions (multimorbidity) and severe pressure on health and care budgets. ‘Integrated care’ is pitched as the solution to current health system challenges. But, in the literature, what integrated care actually involves is complex and contested. Aims: 1. What does ‘integrated care’ currently look like in practice in the NHS? 2. What is the effectiveness of current models of ‘integrated care’? 3. To what extent are there differential effects of ‘integrated care’ for different types of multimorbidity? Methods: The thesis utilises routinely collected data, systematic review and meta-analysis, combined with quasi-experimental methods (difference-in-differences, and subgroup analysis, difference-in-difference-in-differences). Results: The current implementation of the concept of integrated care is predominantly carried out through multidisciplinary team (MDT) case management of ‘at risk’ (usually of secondary-care admissions) patients in primary care. This approach, however, has not proven capable of meeting health outcome and utilisation/cost aims. Patient satisfaction, though, is consistently improved by the approach. There might also be positive spill-over effects of increased team-working through MDTs for the wider practice population. There does not appear to be a multimorbidity subgroup which benefits significantly more than others in terms of secondary-care utilisation or cost. However, patients at the end of life and/or those with only primary-care sensitive conditions might benefit slightly more than others. Conclusions: Integrated care, in its current manifestation, is not a silver bullet that will enable health systems to simultaneously accomplish better health outcomes for those with long-term conditions and multimorbidity while increasing their satisfaction with services and reducing costs. The current financial climate might mean that other means of achieving prioritised aims are required in the short-term, with comprehensive primary care and population health strategies employed to better prevent/compress the negative effects of lifestyle-associated conditions in the longer-term.

Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2007 / This study focuses on the specialised field of Nurse Case Management and the need for formal training for Nurse Case Managers (NCMs). In particular, the study aimed to establish what the outcomes should be of a learning programme for practising NCMs in South Africa. I used a descriptive survey study design. Data was collected using the Delphi technique. The Delphi technique involves questionnaires to be distributed, collation of the data returned and the distribution of a revised questionnaire for input from the participants. Each questionnaire distributed becomes a 'round' and forms part of the process of data collection. A group of experts working in the field of managed healthcare (MHC) were included as the study respondents. Consensus was reached after three rounds as to what the learning outcomes for NCMs should be. This study found that NCMs practising in South Africa require a specialised set of competencies that are not covered in the basic general nursing training. A learning programme for this area of specialisation needs to include outcomes related to relevant legislation, a code of ethics, managerial and clinical competence, administrative competence in managing contracts, good governance, research, (data analyses) and (business) reporting within the context of MHC.

Det råder delade meningar om implementeringen av evidensbaserad praktik i socialt arbete. De olika uppfattningarna går från att förespråkarna hävdar att en evidensbaserad praktik säkerställer att de professionella ges bästa möjliga förutsättningar för sitt yrkesutövande och förvaltande av dennes kompetens, genom att beforskade metoder kvalitetssäkrar tillämpningen – medan dess belackare ser det som en stelbent och styrd arbetsform som på sikt riskerar urholka den professionella kompetensen. Samtidigt testas i en svensk kommun ett nytt sätt att arbeta, ett sätt som inspirerats av case management och som innebär ett brett handlingsutrymme för de professionella samt att klienten äger sin egen problemformulering. Då case management stått som inspiration för arbetssättet, vilket har tagit fasta på vissa inslag av detta, har denna studie undersökt två fall som inspirerats av detta – dels det nämnda fallet med det breda handlingsutrymmet, dels ett som arbetar med ett manualstyrt, evidensbaserat arbetssätt. Denna studies syfte var att förstå hur professionella som arbetar med arbetssätt inspirerade av case management upplever relationen till klienterna och hur de professionella upplever sin roll i relation till arbetssättet. Tanken var att på detta sätt bidraga till den framtida utvecklingen av case management inom socialt arbete, samt att bidraga till den rådande diskussionen rörande evidensbaserad praktik inom detsamma. För att uppnå detta nyttjades ett kvalitativt, hermeneutiskt närmande, med teoretiska utgångspunkter i form av teorier om makt och roller. Intervjuerna analyserades genom kodning, kategorisering och tematisering. I resultatet såg vi två övergripande teman i form av makt och samverkan; temat makt handlade om vilka spelregler som råder mellan klient och professionell, vad arbetssättet utgör för faktor i samspelet, och temat samverkan handlade om en växelverkan mellan bemötande och förtroende mellan den professionelle och klienten. Trots arbetssättens olikheter, fann de professionella inom båda fallen relationen till klienten som central för arbetet, samt såg sitt arbetssätt som passande för att uppnå den relation som arbetet fordrar. Gällande arbetssättets ramar, fanns en skillnad i att det manualstyrda fallet såg sina fasta ramar som en trygghet i arbetet, både för sig själva och klienten – medan det andra fallet tvärt om såg sin relativa avsaknad av ramar som en tillgång för att möta klienten på dennes villkor. Sett till maktaspekterna i arbetet fanns en tydligare strukturell makt, disciplin, i det mer styrda arbete som utfördes i det manualstyrda fallet, samtidigt som inslag av reflexiv styrning fanns hos fallet som lät klienten äga problemformuleringen. Informanternas förmedlade upplevelser av respektive arbetssätt visar på att samtliga ser sitt arbetssätt som för ändamålet positivt och tillräckligt. Således pekar studiens resultat mot att ett styrt arbete inte behöver uppfattas som negativt, så länge som styrningen tjänar arbetets syfte kan den tvärtom upplevas som positiv. Informanternas förmedlade rollupplevelse visade på en skillnad. De professionella vid det manualbaserade sättet förmedlade klara spelregler för klienterna som dessa hade att förhålla sig till, samtidigt som det andra arbetssättets informanter fokuserade på klientens önskemål och såg sig som möjliggörare. Gemensamt för båda fallen var dock att de såg sig som hjälpare, där för klientens bästa. Alltså skiljer sig inte grundsynen på den egna rollen mellan de olika fallen, trots arbetssättens olika art.

Social workers often take on the role of providing case management to Medicaid recipients; however, there is little clinical research on social workers' perceptions of their case management role. The purpose of this study was to develop an understanding of the social worker case management role by exploring social workers' perceptions of their roles when providing case management to Ohio Medicaid managed care enrollees. This action research study was grounded in organizational role theory. A semi structured focus group was facilitated using open-ended questions related to social workers' role perceptions, role conflict, role ambiguity, case management, and managed care. Qualitative data were collected from 5 licensed Ohio social workers working as case managers with clients enrolled in an Ohio Medicaid managed care plan. The data were coded and analyzed using constant comparison analysis to identify relevant themes. Four themes emerged from the data: care coordination, role conflict and ambiguity, lack of social work influence in managed care, and resources. The findings of the study may serve as a step toward filling gaps in the understanding of the role of social workers who provide case management services to Ohio's Medicaid managed care enrollees. The findings may also be used to effect positive social change by increasing stakeholders' understanding of social workers' roles in case management and encouraging stakeholders to take steps to identify and address possible role conflict and ambiguity.

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Grounded theory research was conducted with twenty-four male and female emergency shelter operators (alternatively known as caseworkers) from three different shelters in a large Canadian city: The Open Arms, Good Samaritan and Rescue Mission. Drawing on the experiences of those working in non-profit ‘homeless’ shelters, and based on the sociological concept of ‘dirty work,’ this study describes why caseworkers take on this kind of work, how they make sense of it, and what they themselves get out of it. This research reveals a complex picture of frontline emergency casework that others see as objectionable, dangerous and tainted is described by informants with a sense of job satisfaction, dignity, collective esteem and pride. Moreover, it illuminates the ways in which individuals and occupational groups reframe and subjectively construct meanings about what it means to be involved in ‘dirty work’ such that it is regarded positively and as ‘good work’. Because caseworkers deal in difficult emotions, they must learn to perform a balancing act between professional decorum and expressed concern. The ways that caseworkers are supposed to perceive their roles are governed by a set of unwritten norms and rules that normalize and renarrate disruptive and abnormal situations of a caseworker being humiliated, berated, verbally and physically attacked and by which they accept this as normal and therefore morally acceptable. It was typical for frontline caseworkers, working in non-profit shelters, to emphasize the relational and affectual rewards of the job as a compensation for its low pay and dirty ‘particulars,’ which meets the expectations, self-conceptions and values they hold themselves to be as caring and compassionate workers. They accomplish this by redirecting attention to the more dignifying aspects of their jobs and by identifying strongly with both their occupations and the collective identity of their occupational culture. This research further underscores both the importance of understanding the interpretive processes of meaning-making and the social construction of ‘dirt’. / Thesis / Master of Arts (MA)