Zugl.: München, Universiẗat der Bundeswehr, Diss., 2009.

Zugl.: Basel, Univ., Diss., 2005

Substance abuse and dependence has been a problem in the United States for over 100 years (Whitebread, 1995). In the past two decades the abuse and dependence of methamphetamine has increased and the rates have remained steady (Substance Abuse and Mental Health Services Administration, 2004). Advances have been made in the development of treatments for substance abuse and dependence. Research has continued to show that treatment modalities enhanced by case management services are more effective in the treatment of substance abuse and dependence. There has also been progress made in the research regarding the therapeutic benefits of employment for persons with substance abuse and dependence. However, the research regarding methamphetamine abuse and dependence is lacking in regards to the effects of employment, and the case management needs of this population. The aim of this study is to expand research on methamphetamine abuse, dependence, and treatment. By using variables including measures of demographics, education, income, utilization of substance abuse treatment services, healthcare coverage, measures of mental health status, measures of physical health status, and measures of arrest record to predict employment status of persons who report methamphetamine use, implications were developed for treatment providers and case managers to increase the effectiveness and efficiency of treatment. The present study utilized the 2006 and 2007 National Survey on Drug Use and Health data to determine if measures of demographics, education, income, utilization of substance abuse treatment services, healthcare coverage, measures of mental health status, measures of physical health status, and measures of arrest record have significant associations to employment status of persons who report methamphetamine use. A chi-square analysis was used to determine which variables have significant associations to employment status. In addition, this study sought to determine if these independent variables are significant predictors of employment status among methamphetamine users. A binary logistic regression analysis was used to predict employment. The results of the study showed that several of the independent variables had significant associations to employment status of persons who report methamphetamine use. However, the binary logistic regression analysis only resulted in one significant predictor. The results of this study were used to develop implications for case managers.

Community case management services provide targeted care to patients with long term health conditions (LTCs) and complex needs, at high risk of adverse events such as emergency hospital admissions. However, there is no standardised evidence informed programme for providing such care, including for patient monitoring. The complexity of older patients, those most likely to have multiple LTCs, and who often present with frailty and atypical symptoms, enhance the difficulty of on-going monitoring and targeting of care. There is an established relationship between ageing and LTCs, frailty and muscle strength, and function and service use, suggesting that muscle strength may be a useful aid to monitoring. Whilst muscle strength is a known indicator for future health, it is not known whether monitoring it is feasible or useful as a short term indicator in older people, especially those at high risk of adverse events. Patients are initially identified for case management by predictive modelling and/or clinical judgement, but little is known about the patients who go on to receive such care. The feasibility and usefulness of routine measures of muscle strength to help clinicians provide timely interventions were investigated alongside case management patients’ health, functional and physical status. An initial pilot study in healthy older adults (n=21) investigated four portable measures of strength, grip strength, sniff nasal inspiratory pressure (SNIP), peak inspiratory flow (PIF) and peak expiratory flow (PEF), and confirmed, via the collection of repeated measures at two time points one week apart, the reliability and acceptability of all but SNIP. A follow on feasibility study explored the acceptability and stability of the three successfully piloted measures in case management patients (n=8) and clinicians (n=5) via researcher administered questionnaire, with the reliability and stability of the measures assessed using a variety of statistical tests including intra-class correlation coefficients and Bland-Altman plots, on data collected over a maximum 7 week period. Concurrently measures of physical and functional ability and health were conducted. A third study analysed routine primary and secondary care case management patient data (n=101), allowing the development of a health and demographic profile of patients, including an assessment of frailty. The pilot and feasibility studies confirmed the reliability and acceptability of three portable measures of strength, PIF, PEF and grip strength. The high level of muscle strength stability observed in patients over the short-medium term, despite adverse events, suggested that whilst monitoring muscle strength may be feasible it would not be useful over this time period. Analysis of routine primary and secondary care data, identified case management patients as predominately female, with age skewed towards the older old and experiencing high levels of deprivation. Multiple LTCs were commonly recorded, and a wide variety of conditions noted. Health service use varied greatly, with few patients recording frequent usage. A frailty index suggested that frailty was common, and highlighted the potential for the development of a useful frailty index using routine data to improve the targeting of case management services towards those who are most at risk.

Zugleich: Diss. Staatswiss. Basel, 2005. / Literaturverz.

Dans le monde des affaires d'aujourd'hui, les besoins des clients changent plus rapidement que jamais et le nombre de concurrents augmente chaque seconde. De plus, la capacité à gérer les changements et l'imprévisibilité sont devenus un facteur crucial pour que les entreprises gagnent en valeur et restent compétitives [Oracle 2013]. Il en résulte que les entreprises sont aujourd'hui confrontées non seulement à la gestion de processus métier structurés, mais également à des processus de plus en plus non structurés. Dans un processus métier structuré commun, tout ce qui concerne le processus peut être prédéterminé au moment de la conception, tel que les activités, la séquence d'exécution des activités, etc. Cependant, dans une structure non structurée, les activités ne peuvent pas être définies précisément au préalable, ainsi que la séquence à exécuter. Pour rester compétitives, répondre aux demandes du marché en constante évolution et améliorer l'efficacité opérationnelle de leurs processus d'affaires, les organisations ont besoin d'une approche de processus novatrice qui peut les aider à gérer les changements, la dynamique et l'imprévisibilité. Dans ce contexte, le concept de Case Management est proposé. Différent du Business Process Management (BPM) qui standardise et automatise les processus métier structurés, CM surmonte les limites de l'approche BPM et fournit une infrastructure pour gérer les changements, la dynamique et l'imprévisibilité dans les processus métier non structurés. Le CM procède en grande partie en fonction de l'évolution des circonstances, et les décisions sont prises à la volée. BPM nécessite un haut niveau de prévisibilité; considérant que le CM a un niveau de prévisibilité moindre mais un niveau d'adaptabilité et de flexibilité plus élevé. Avec l'approche CM, les entreprises sont en mesure de gérer leurs processus métier non structurés de manière plus souple et plus flexible.Cependant, pour ce nouveau domaine, il manque des méthodes de soutien et des outils logiciels. Les principales préoccupations sont: (1) la modélisation de cas (la construction de modéles de cas); (2) la découverte de modèles (l'établissement de modèles de cas à partir de données brutes); (3) l'analyse de modèles (l'analyse de modèles à la fois statiques et dynamiques, par exemple, la dérivation de propriétés avant la mise en place du cas); (4) amélioration du modèle (réduction des coûts, optimisation de la performance opérationnelle, etc.); et (5) la promulgation du modèle (l'exécution d'un scénario avec des case workers dans la boucle). Après un examen approfondi de la littérature, nous avons constaté que seulement quelques efforts ont été faits dans (1) et (5), et aucune contribution notable n'a été faite dans d'autres aspects.Ceci présente notre approche CM qui fournit aux assistants un support complet dans tout le cycle de vie du CM: de l'établissement de modèles de cas à partir de données brutes jusqu'à l'optimisation des modèles de cas. Process Tree est notre choix pour formaliser le modèle découvert, et CMMN (Case Management Model and Notation, une spécification de modèlisation de cas est choisie comme formalisme pour la présentation et la construction de modèles de cas.) En outre, nous adoptons le langage HiLLS. L'analyse de modèle dynamique est permise par le formalisme DEVS, l'analyse de modèle statique est fournie par des méthodes formelles. Quand à la mise en oeuvre de modèle, elle est permise par la mise en ?uvre d'une spécification orientée objet du cas. Nous proposons principalement deux modules: un module concernant la découverte du modèle de cas à partir des historiques d'événements, et un autre module concernant l'amélioration et l'optimisation du modèle de cas. / In today's business world, customer requirements change more rapidly than ever before, and new competitors are increasing every second. Moreover, the ability of managing changes and unpredictability has become a crucial factor for enterprises to make more value and stay competitive [Oracle 2013]. This results in a fact that nowadays enterprises are challenged with not only managing structured business processes, but also more and more unstructured ones. In a common structured business process, everything regarding the process can be predetermined at design time, such as activities, the execution sequence of activities, and so on. However, in an unstructured one the activities cannot be defined precisely beforehand, as well as the sequence to execute. To stay competitive, meet the ever-changing market demands and improve their business process operational efficiency, organizations need a novel process approach that can help them manage changes, dynamics and unpredictability. Under this context, the concept of Case Management is proposed. Different from Business Process Management (BPM) which standardizes and automates structured business processes, CM overcomes the BPM approach limitations and provides an infrastructure for managing changes, dynamics and unpredictability in unstructured business processes. CM proceeds largely depending on evolving circumstances, and decisions are made on the fly. BPM requires a high level of predictability; whereas CM has a lower level of predictability but a higher level of adaptability and flexibility. With CM approach, enterprises are able to manage their unstructured business processes in a more adaptive and flexible manner.However, for this new area it lacks supporting methods and software tools. Major concerns are: (1) case modeling (the construction of case models); (2) model discovery (the establishment of case models from raw data); (3) model analysis (the analysis of models in both static and dynamic manners, e.g., the derivation of properties before the case is enacted); (4) model improvement (the reduction of cost, the optimization of operational performance, etc.); and (5) model enactment (the execution of a case scenario with case workers in the loop). After a thorough literature review we found that only a few efforts have been done in (1) and (5), and no noticeable contribution has been done in other aspects.This these presents our CM approach that provides case workers full supports in the whole lifecycle of CM: from establishing case models from raw data to optimizing case models. Process Tree is our choice to formalize the discovered model, and CMMN (Case Management Model and Notation, a case modeling specification is selected as the formalism for presenting and constructing case models. In addition, we adopt the HiLLS (High Level Language for Systems Specification) formalism to conciliate usability, simulation ability and formal analysis capabilities together. Dynamic model analysis is enabled by DEVS formalism, static model analysis is provided by formal methods, and model enactment is given by the implementation of an object-oriented specification of the case. We propose mainly two modules in this these: one module concerning the discovery of the case model from historical event logs, and another module concerning the improvement and the optimization of the case model.

No description available.

Taiwanese health authorities are increasingly applying case management as a health care delivery strategy in the community. However, most Taiwanese public health nurses (PHNs) do not receive case management education because there are few education programs available. Several limitations in existing evaluative studies of case management continuing education programs were identified. These methodological weaknesses limit the conclusions that can be drawn about the effectiveness of these education programs. Hence, the purpose of this study was to develop, implement and evaluate a collaborative case management continuing education program for Taiwanese PHNs. The study was divided into three phases, with an expanded theoretical framework used to guide the program development, implementation and evaluation. Phase One conducted focus group discussions in order to assess the educational needs of Taiwanese PHNs. Phase Two developed a collaborative education program based on the findings of a literature review and the needs assessment. The initial program was evaluated by an expert panel and pilot testing was undertaken. Phase Three implemented and evaluated the program using an experimental research design and mixed evaluation methods. Three outcome levels were assessed, namely reaction, learning and performance by examining changes in PHNs' case management knowledge, skills and practice. The participants in the study were PHNs employed in health centres in Taipei City. The program itself involved 16 hours of workshops through four half-day sessions, conducted every two weeks during the participants' work time and at their workplace. Two types of data, focus group data and questionnaire data, were collected during the course of the study. The focus groups were conducted before and after the program delivery, for the needs assessment and program evaluation, using a subset of the participants. The focus groups were moderated by the researcher, who used a focus group discussion guide to collect data. The other data set was collected using self-report questionnaires. The participants were randomly allocated into two groups using cluster sampling, the experimental and comparison groups. Both groups were given questionnaires before the education program commenced, and then again eight weeks after the program was completed. For ethical considerations, PHNs in the comparison group also received the same program after data collection. The results revealed that the majority of participants were satisfied with the program. The education intervention significantly improved PHNs' case management knowledge, performance skills confidence, preparedness for case manager role activities, frequency of using case management skills, and frequency of using these role activities. A number of changes in case management practice were reported, in particular that the participants tended to follow the case management process more often and focus more on the quality of case management. This study was guided by an integrated theoretical framework, and used a clustered randomised controlled design to assess the effectiveness of the program across multiple levels of outcomes, hence addressing the design deficits identified in the prior evaluative studies. This study therefore provides an important contribution to the fields of nursing and case management by developing, implementing and evaluating a case management education program. Additionally, the program itself offers an evidence-based educational experience for PHNs and provides a new tool for nursing education in the context of Taiwan.

The overall aim was to explore the experiences and knowledge of Personligt Ombud (PO) (a Swedish version of Case Management) and how they relate to the client's recovery as well as their own role of supporting clients in the recovery process. The thesis consists of four original papers (I-IV), and both quantitative and qualitative methods were used. Paper I showed that there were differences in knowledge and attitude toward recovery between three personnel groups: psychiatric outpatient services (POPS), the supported housing team (SHT) and the PO service, where the POs showed greater knowledge about recovery than both POPS and SHT. The results also indicated that university education and training in recovery was positive related to knowledge and attitudes towards recovery. Findings from papers II - IV showed that the clients' choices permeated all of the work that the POs and clients did together. The strategies used by the POs put the client in an active changing process, where he/she became involved in every aspect of the process. The work of the PO included discussions and collaboration with clients. The relationship with the client was the foundation of the work, and it was important to build a working alliance, which also involved a personal dimension. The findings also showed that POs experienced their role as unbounded, where they didn't have to consider any organizational frames, and POs solely represent the client. However, the free role was also connected with responsibilities concerning their work, and POs had to be able to work independently. The role as POs also enables to get a holistic view to both the client as well as to the welfare system. However, the freestanding role demanded legitimacy, and the POs had to work for this. It was important for the PO service to develop good platforms for cooperation with other actors in the society. In conclusion, it is interesting and leads to the question of whether POs and personnel in POPS can relate to two different kinds of recovery: personal vs. clinical. It may be important to consider the need for university education and training in recovery developing recovery-oriented practices. Findings showed that the PO service has developed a method in accordance to the NBHW guidelines, which in many cases, may benefit the clients' recovery process; however, there were aspects the PO service needed to develop. They seemed to use a problem-oriented approach, and they need to change this and look at the clients' strengths, both individual and environmental, and use them in order to support the client to reach goals in life. In Strengths Model Case Management, the Strengths assessment exists, that may be useful. The POs' service also needs to strengthen their organization and possibly develop support among colleagues. / Det övergripande syftet var att undersöka Personligt Ombuds (PO) (en svensk variant av Case Management) erfarenheter och kunskap om återhämtning och hur de använder sig av detta samt deras roll i klientens återhämtningsprocess. Avhandlingen består av fyra originalarbeten (I - IV), där både kvantitativa och kvalitativa metoder användes. Paper I visade att det fanns skillnader i kunskap om återhämtning mellan tre personalgrupper: personal inom psykiatrisk öppenvård, boendestöd och PO verksamheter där det visade sig att POs hade mer kunskap om återhämtning än personal både inom psykiatrisk öppenvård samt boendestödet. Resultatet visade även att universitetsutbildning samt fortbildning i återhämtning hade positiv inverkan på kunskap om återhämtning. Resultaten från paper II - IV visade att klientens val genomsyrade allt arbete som PO och klienten gjorde tillsammans. De strategier som PO använde satte klienten i en aktiv förändringsprocess, där han/hon blev involverad i varje del av processen. Det var viktigt för PO att diskutera och samarbeta med klienterna. I klientarbetet var relationen med klienten en grundbult, där det var viktigt att bygga en allians med varje klient, som även innehöll en personlig dimension. Resultatet visade även att PO upplevde sig obundna i sin roll där de inte behövde anpassa sitt arbete utifrån organisatoriska ramar och tillhörighet, viket bidrog till att PO upplevde att de enbart representerade klienten. Men den fria rollen innebar även att ta ansvar i sitt arbete då PO måste kunna arbeta självständigt. Rollen som PO möjliggör att skapa en helhetssyn på både klienten samt välfärdssystemet. Den fristående rollen krävde legitimitet där PO där det är betydelsefullt att utveckla goda plattformar för samarbete med andra aktörer i samhället. Sammanfattningsvis är det intressant att reflektera om olika yrkesgrupper relaterar till två olika definitioner av återhämtning: personlig vs klinisk återhämtning. I utvecklingen av en återhämtningsinriktad praktik kan det vara betydelsefullt att beakta behovet av personal som är utbildade på universitetsnivå samt fortbildning i återhämtning. Resultaten visade att PO har utvecklat en metod utifrån Socialstyrelsens riktlinjer, vilket i många fall möjligtvis kan gynna klientens återhämtningsprocess, men det finns delar i PO verksamheten som behöver utvecklas. De verkade använda ett problemorienterat förhållningssätt och de bör utveckla verksamheten till att identifiera klienten styrkor, både individuella och miljömässiga och använda dessa för att stödja klienten att nå mål i livet. I Strength Model Case Management finns ett instrument där man tillsammans med klienten inventerar styrkor. Dessa kan bli användbara i processen. PO verksamheten bör även stärka organisationen och eventuellt utveckla stöd bland kollegor.

South Africa experienced a major measles outbreak from 2009 to 2011. This study was done to describe the patient profile of children admitted with measles for a period during the outbreak. It includes patient demographics, clinical presentation, management and outcomes. An audit of the notification system was also performed.