Cost and health effects of case management compared with outpatient clinic follow-up in a Dutch heart failure cohort

Models Used by Nurse Case Managers in Different Autonomous Communities in Spain: A Scoping Review

(1) Background: The role of the nurse case manager is unknown to the population. The main objective is to analyze the existing differences within the national territory in order to make known the situation in Spain with a view to the recognition of its functions and the creation of the professional profile in an equal manner. (2) Methods: A scoping review was conducted in order to achieve the main aim. Selected articles were subjected to a critical reading, and the levels of evidence and grades of recommendation of the Joanna Briggs Institute were verified. The search field was limited to the last ten years. (3) Results: Case management models are heterogeneous in different autonomous communities in Spain. Case nurse management is qualified for high-complexity patients, follow up on chronic patients, and coordinate health assistance. (4) Conclusions: It concludes that nursing's role is crucial in the field of case management, being required in the follow-up of chronic patients of high complexity. Despite the proven health benefits, efficacy, and efficiency of case management, there are many heterogeneous models that coexist in Spain. This involves a restriction in the development of a nursing career because of the lack of a definition of its functions and competences.

Overcoming a Pandemic:: How Engineering and Modeling Techniques Are Used to Inform a Health System From Preparation to Recovery from the COVID-19 Pandemic

COVID-19, a novel disease that spreads across the globe, has posed multiple challenges to the healthcare systems around the world. Due to the lack of understanding of the spread and management of this disease, one major challenge is for healthcare systems to anticipate the volumes and needs of patients infected with the disease. In order to provide insights into optimal allocation of resources from preparing ChristianaCare for the pandemic to the recovery of the healthcare system, industrial engineering and predictive modeling approaches are used. This paper discusses five interrelated studies that utilize various techniques to inform multiple aspects of the healthcare system in order to be better prepared for the pandemic.

Implementation of nursing case management to improve community access to care: A scoping review

Background

Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings.

Objectives

This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications.

Design

This study was conducted following the framework of scoping review.

Data Sources

The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included.

Review Methods

The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result.

Results

A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training.

Conclusion

Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses' advocacy competence for future implications.

Costs and healthcare utilisation of patients with heart failure in Spain

BACKGROUND

Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain.

METHODS

Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.

RESULTS

We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs.

CONCLUSIONS

During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.

Cost and health effects of case management compared with outpatient clinic follow-up in a Dutch heart failure cohort

Aims

Heart failure reduces quality of life and life expectancy; hospital admissions are frequent and create a burden on public resources. This study aims to quantify the benefits in terms of health effects [quality‐adjusted life years (QALYs)] and costs when heart failure patients receive case management at home compared with outpatient cardiology clinic follow‐up.

Methods and results

A health state transition (Markov) model was written, and transition probabilities were derived from a cohort of 1114 patients and available literature. QALYs in different health states of heart failure patients were retrieved from the literature, and costs were estimated with data from the financial department of the Noordwest Ziekenhuisgroep and public cost sources. Monthly simulation cycles were repeated 60 times to generate 5 years of virtual follow‐up data. Baseline willingness to pay is assumed €50 000 per QALY. Sensitivity analyses were performed in a one‐way deterministic and a multiway probabilistic approach; the probabilistic approach used uniform and more plausible distributions of the model parameters.

Case management reduced costs by €382 and increased QALYs by 0.261 for the baseline simulation; this results in a net monetary benefit of €13 428. Probabilistic sensitivity analysis based on uniform and most plausible distributions of parameters resulted in 96.2% and 83.3% of the simulations, favouring a treatment strategy of case management.

Conclusions

Case management is cost effective in 83.3% of the probabilistic simulations and has a tendency towards reducing costs and increasing QALYs when considering a real‐world cohort of heart failure patients in the Netherlands.