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Managing Care for Adults With Long-term Medical Illnesses

Consumer Summary – Aug. 30, 2013

Managing Care for Adults With Long-term Medical Illnesses

Formats

Table of Contents

Is This Information Right for Me?

If you meet all of the following, this information is for you:

  • You or someone you care for has one or more long-term medical illnesses, such as congestive heart failure, cancer, diabetes, dementia, or tuberculosis (also called TB).
  • You are considering case management (when a nurse or social worker helps manage your care needs or those of someone you care for). Case management may have been suggested to you by a doctor* or insurance provider.
  • You are age 18 or older. The information in this summary is from research on adults.
Note: This summary does not discuss case management for patients with psychiatric illnesses such as depression, schizophrenia, or bipolar disorder. For information about case management for people with psychiatric illnesses, ask your doctor.

What will this summary cover?

This summary will cover:

  • What case management is and for whom it might be helpful
  • What researchers have found about case management for people with long-term medical illnesses

This summary can help you decide if case management may be right for you or someone you care for.

Where does the information come from?

Researchers funded by the Agency for Healthcare Research and Quality (AHRQ), a Federal Government research agency, reviewed 109 studies on case management for people with long-term medical illnesses published through August 2011. The report was reviewed by clinicians, researchers, experts, and the public. You can read the report by clicking on the link for "Research Review" on the right side of this page.

* In this summary, the term “doctor” refers to your health care professional, including your primary care physician, specialist, nurse practitioner, or physician assistant.

Understanding Case Management

Case management is a service in which a nurse or social worker helps manage or coordinate care for someone with a long-term illness. Care for people with long-term illnesses can be complex and might involve several different doctors and treatments.

A case manager can serve as a bridge between patients or caregivers and their doctors, the health care system, and community resources. Case managers may meet with patients and caregivers in their homes, in the doctor’s office or clinic, or by phone.

A case manager can help both with medical tasks and in coordinating care.

Medical tasks can include helping patients:

  • Better understand their illness and care plan
  • Watch for changes in their illness
  • Work with their doctor to make sure they get the right care
  • Work with their doctor to adjust medicines
  • Follow their doctor’s care instructions
    • For example, helping patients take their medicine, check their blood sugar or blood pressure, or follow a certain diet
  • Learn how to manage their own illness

Coordinating care can include helping patients:

  • Navigate the health care system and their health insurance plan
  • Stay connected with all their doctors and other health care professionals
  • Make appointments for doctor visits, medical tests, or treatment sessions
  • Connect with helpful community resources
    • For example, support groups, groups that provide meals or transportation, and services to give caregivers a break

Who might case management help?

Case management could help people with complex care needs, such as people with:

  • Many long-term illnesses
  • Congestive heart failure
  • Cancer
  • Tuberculosis (TB)
  • Diabetes
  • Dementia (forgetfulness, confusion, and agitation caused by illnesses such as Alzheimer’s disease)

Elderly couple reviewing information with a case worker

How do you get a case manager?

Some doctors assign a case manager to patients they think the added support may help. Health insurance providers often offer case management to patients with long-term medical illnesses. You may get a letter from your health insurance provider about case management.

Different health insurance providers may have different names for case management, such as “disease management,” “care coordination,” or “self-management support.” Some types of “home health care” may involve case management. You or your doctor can contact your health insurance provider to find out if case management is covered for you or someone you care for.

What have researchers found about case management for people with long-term medical illnesses?

Researchers found that case management seems to work best when case managers:

  • Work closely with patients’ doctors and other health care professionals
  • Work closely with patients and/or their caregivers over a long period of time
  • Talk with patients and/or their caregivers face-to-face rather than only on the phone

Researchers also found these results about people who used case management for different illnesses:

Older adults with more than one long-term illness:
  • Felt their care was better coordinated
  • Were not better able to do daily tasks (such as dressing, bathing, or other tasks to take care of themselves)
  • Did not go to the hospital less often
People with congestive heart failure:
  • Felt more pleased with their care
  • Were better able to follow their doctor’s instructions
People with cancer:
  • Felt more pleased with their care
  • Were better able to get the care recommended for their type of cancer (for example, getting radiation treatments or chemotherapy)
People with diabetes:
  • Appeared to be better able to control their blood glucose (sugar), but more research is needed to know this for sure
  • Were not better able to control their lipids (a type of fat in the blood) or weight
Caregivers of people with dementia:
  • Had less stress and depression
  • Were not able to delay placing the person they care for in a nursing home when case management lasted 2 years or less
People with dementia:
  • Did not have fewer behavior problems
People with tuberculosis:
  • Were more likely to have successful treatment

Making a Decision

What should I think about?

There are many things to consider when deciding if case management may be right for you or someone you care for.

You should think about:

  • The possible benefits of case management
  • Your ability to meet with a case manager
  • How comfortable you are with having someone help manage your own care needs or those of someone you care for
  • How comfortable you are with having someone come to your home to meet with you

What are the costs of case management?

Health insurance providers may cover the cost of case management for patients with long-term illnesses. Contact your health insurance provider for more information.

Ask your doctor

To answer some of these questions, you and your doctor may need to talk with your health insurance provider:

  • Do you think case management could help me?
  • Is a case manager available through your office or through my health insurance provider?
  • Will you contact my health insurance provider, or should I contact them?
  • How long will the case manager work with me?
  • How often will the case manager meet with me?
  • Where will I meet with the case manager—at my home, at the doctor’s office or clinic, or by phone?
  • What specific tasks could a case manager help me with?
  • Will the case manager work directly with you and my other doctors and health care professionals?
  • Will the case manager come with me to any of my health appointments?
  • Are there any reasons not to have a case manager?

Ask your health insurance provider

  • Can I get a case manager for myself or for someone I care for?
  • Is case management completely covered under my health insurance plan? Will I need to pay anything?
  • How do I sign up for a case manager?

Sources

The information in this summary comes from the report Outpatient Case Management for Adults With Medical Illness and Complex Care Needs, January 2013. The report was produced by the Oregon Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ).

Additional information came from the MedlinePlus® Web site, a service of the National Library of Medicine and the National Institutes of Health. This site is available at www.nlm.nih.gov/medlineplus.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Amelia Williamson Smith, M.S., John C. Rogers, M.D., M.P.H., M.Ed., and Michael Fordis, M.D. People with long-term medical illnesses or their caregivers reviewed this summary.

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