Introduction
Despite efforts to improve the way that health systems deliver care internationally, there remains a high degree of fragmentation between services making it difficult for clients and their carers to navigate these effectively (Joo & Huber, 2014). Fragmentation of care has been identified as a key factor contributing to hospital readmissions, poor quality of life, low levels of satisfaction and increased health costs (Chow & Wong, 2014; Joo & Huber, 2014). Some authors report that as much as 80 per cent of health care costs can be attributed to some 10 per cent of the community (Hudon et al., 2015). This relatively small group can be seen to have complex health needs, compounded often by factors such as multi-morbidity, socio-economic disadvantage and low health literacy (Chouinard et al., 2013), which leads to high health care utilisation.
Case management is one model of care that aims to address complex health needs through a structured approach to health care delivery, which promotes self-management and integration of health services (Gage et al., 2013; Hudon et al., 2015). The case management model is typically comprised of assessment, planning, implementation, evaluation and interaction (Clayton et al., 2011; Williams & Kralik, 2011). These steps are undertaken as a collaborative partnership process between health professionals, clients and, where appropriate, carers/family/significant others (NSW Health, 2007). Partnership in health care refers to the concept of shared responsibility for the treatment outcome, placing the individual at the centre of the care delivery rather than simply being a passive recipient of care.
Case managers characteristically provide long-term care for individuals rather than episodically during periods of exacerbation or acute illness (White & Hall, 2006). While case managers in health can have various professional backgrounds, nurses are particularly suitable case managers given the close links between the nursing process and the framework of case management (Parker & Fuller, 2016; White & Hall, 2006). Nurses can work as case managers in in a range of primary health care settings such as general practice or community nursing services, or offer specialist case management with particular client groups (for example, heart failure, diabetes or respiratory disease)(Gage et al., 2013; Parker & Fuller, 2016).
This chapter explores the concepts of case management, identifies the evidence for the use of this model and the skills needed by nurse case managers.