Article Figures & Data
Figures
- Figure 1
Study selection process.
CM = case management; CMO = context, mechanism, and outcome.
- Figure 2
Refined program theory.
Tables
Term Definition Context (C) Aspects of the background of the intervention (eg, characteristics of the people involved in the intervention, the environment in which the intervention occurs, the social and political context, etc) Mechanism (M) The generative, causal force influencing the effect of program resources on participants’ reasoning, attitudes, and behaviors (sensitive to variation in context) Outcome (O) Effect of the intervention, dependent on the interactions between the context and mechanism CMO configuration Relation between context, mechanisms, and outcomes that is a form of realist causal explanation Initial program theory A preliminary exploration of the theory on how the intervention works Demiregularity Semipredictable patterns that could emerge from CMO configurations that appear repeatedly, or the interpretation of which is strongly supported by theory Program theory An empirically testable proposition that lies in an intermediate position relative to generalizable grand theories of social systems on one end and detailed descriptions of situational microphenomena on the other Case manager Health care professional who provides the intervention. Can also refer to the CM team Frequent user Individuals/patients who frequently use health care services. Can also include their family and caregivers Health care clinician Health care professionals involved in the case management intervention (eg, emergency department staff, family physician, etc) Self-management support Activities the purpose of which is to help patients and their families play a greater role in the management of their health CM = case management; CMO = context + mechanism = outcome.
Theme CMO Configuration Evidence (References) Coordination and health navigation If frequent users are directed through the health care system and are enabled to connect with clinicians and community services working in close collaboration (C), they have a better understanding of how to access and obtain relevant health care services in appropriate settings. Their knowledge and ability to navigate within the health care system and to communicate with clinicians are strengthened, and they become more engaged in their care (M). This improves their self-management skills and health status and reduces health care use and costs (O). (CMO 1) Grimmer-Somers et al, 201035; Grinberg et al, 201628; Hudon et al, 201529; Navratil-Strawn et al, 201440; Reinius et al, 201333; Roberts et al, 201530; Shah et al, 201138; Weerahandi et al, 201531 Patient and health care clinician relationship If case managers are able to develop trusting relationships with frequent users (C), frequent users trust them, feel safe, and develop meaningful relationships with them. This meaningful relationship motivates patients to be engaged in their care (M). In turn, their self-management skills improve, their health condition(s) stabilizes, and health care use and costs are reduced (O). (CMO 2) Crane et al, 201232; Grinberg et al, 201628; Hudon et al, 201529; Roberts et al, 201530; Weerahandi et al, 201531 If frequent users have a negative interaction with case managers, feel disrespected, discriminated against, or not connected with them (C), frequent users feel upset, dissatisfied, and frustrated with their encounter. They are unable to develop a trusting relationship with their case managers and are not willing to engage in their care (M). This limits the development of their self-management skills, does not improve their quality of life, and does not change health care use and costs (O). (CMO 3) Grinberg et al, 201628; Sledge et al, 200634 Patient and health care clinician engagement If case managers are flexible, able to adapt, and open to change their approach by involving frequent users in their care planning (C), frequent users tend to accept the CM program, tend to understand their role in it, and are willing to engage in their care (M). This improves their self-management skills, health status, and quality of care and reduces health care use and costs (O). (CMO 4) Adam et al, 201036; Crane et al, 201232; Grimmer-Somers et al, 201035; Grinberg et al, 201628; Hudon et al, 201529; McCarty et al, 201537; Roberts et al, 201530; Weerahandi et al, 201531 If case managers are willing to be engaged and committed to the program and to take an active role in care planning (C), frequent users accept the program, perceive it to be beneficial, and become more engaged in their health care (M), which improves their self-management skills and reduces health care use (O). (CMO 5) Adam et al, 201036; Grinberg et al, 201628; Grover et al, 201044; McCarty et al, 201537; Pope et al, 200042; Skinner et al, 200943; Weerahandi et al, 201531 If frequent users are not involved in their care planning (C), they do not feel engaged and will deviate from their care plan because they do not understand it or do not agree with it (M). Consequently, they will continue to frequently and inappropriately use health care services (O). (CMO 6) Adam et al, 201036; Bodenmann et al, 201739; Pope et al, 200042 If clinicians do not follow the care plan that includes restriction of narcotics for frequent users with substance use issues (C), patients are unwilling to follow the care plan (M) and continue to frequently and inappropriately use health care services to obtain narcotics (O). (CMO 7) Grover et al, 201044; Pope et al, 200042 Patient and health care clinician support If a comprehensive and holistic approach addressing both medical and social issues is provided to frequent users (C), they feel their concerns are heard and their needs are taken seriously. They feel supported and satisfied with the care received and motivated to be engaged in their care (M). This improves their self-management skills and health status and reduces health care use (O). (CMO 8) Brown et al, 200541; Grimmer- Somers et al, 201035; Hudon et al, 201529; Pope et al, 200042; Shah et al, 201138 If frequent users have easy access to case managers who provide regular follow-up meetings (C), frequent users feel supported and cared for in the management of their health issues and trusted by their case managers (M). This improves their self- management skills, health status, and quality of life and reduces health care use and costs (O). (CMO 9) Crane et al, 201232; Hudon et al, 201529; Reinius et al, 201333; Roberts et al, 201530; Weerahandi et al, 201531 If clinicians who are overwhelmed by the complex needs of frequent users in an over- loaded health care system work in collaboration with an interdisciplinary team (C), they feel supported by the members of the team and satisfied with the program and are willing to engage in the CM program (M). This improves the quality of care they provide to frequent users and reduces patients’ health care use (O). (CMO 10) Adam et al, 201036; Brown et al, 200541; McCarty et al, 201537 Self-management support If frequent users are involved in their care planning and receive self-management support (C), they develop a greater understanding of their condition, are motivated to take an active role in their care, and feel confident in their ability to obtain medical and social resources (M). This improves their self-management skills, health status, and quality of life and reduces health care use (O). (CMO 11) Crane et al, 201232; Grimmer-Somers et al, 201035; Grinberg et al, 201628; Hudon et al, 201529; Roberts et al, 201530; Shah et al, 201138; Weerahandi et al, 201531 C = context; CMO = context + mechanism = outcome; M = mechanism; O = outcome.
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