The multiple embedded case study design is ap-propriate to the exploration of complex phenomena, such as PSM in real world settings and allows for com-parison between sites [72]. This, in turn, enabled the grouping of case management types with similar response patterns. 2. All the components and the relevance of all criteria were discussed within the consortium of researchers, based on the results of the multiple case studies. However, the identification of sub-units allows for a more detailed level of inquiry. However, the identification of sub-units allows for a more detailed level of inquiry. 1999;54(11):M546–53. Stakeholders of the projects reported that the use of results of research was important to foster high quality care, ideally also leading to the use of evidence-based protocols or guidelines, and when possible shared with professionals outside the project organisation. They could be included in the project if they met the inclusion criteria set by the Royal Decree. 2012;4(14):3. ); [3] to build an overall analytical framework to explain the success or failure of a project, from a normative point of view [24]. statement and In the second type of case management, where the focus is also on the integration of the care at a social level, the intervention is likely to be more supported by the input of the other professionals, as they benefit from reflective discussions among peers including professionals from outside their organisation and the information about the beneficiaries is shared and organized thanks to a structured software. Health SystTransit. When diversity occurred within an organisation, e.g. Case Studies and Theory Development in the Social Sciences. As was stated by a project manager: “If we did not have these links, we wouldn’t even have achieved a caseload of 80 (instead of 150). Hartmaier SL, Sloane PD, Guess HA, Koch GG, Mitchell CM, Phillips CD. The broker model is similar to the brokerage model described by Lee et al. 38.1 %); (c) both nurses and occupational therapists (n = 1; 4.7 %) or social workers and other professionals (i.e. Furthermore, in the same dimension, financial incentives for general practitioner’s participation was also seen as important, as they are crucial partners in case management. Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. This can be represented by Table I. The inclusion criteria chosen are not seen as adequate while it is expected that case management will be more profitable to people deliberately identified as those with complex care needs [6, 41, 42]. Writing a sociology essay study case embedded Multiple community service project essay. The higher the score, the higher the level of achievement. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. PubMed  The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity. Guinot C, Latreille J, Malvy D, Preziosi P, Galan P, Hercberg S, et al. We plan to carry out further research to test if these components are indeed related with better beneficiaries’ outcomes. Further, they allowed constant comparison within and between cases. The complete list of components, each with their criteria justifying a given score, is displayed in the Additional file 1. Brussels: KCE; 2012. ; [2] annual semi-structured interviews with the stakeholders working in the projects (coordinators, persons responsible for the implementation of the project and frontline workers); [3] yearly questionnaires containing open-ended questions collecting data about the organisational functioning and about adaptations in the components of their projects and [4] written documentation, such as advertising flyers, projects website, etc. PubMed  They are shown in Table 1. In Robert Yin's 2×2 table of types of case studies, the two axes are holistic (single unit of analysis) vs. embedded (multiple units of analysis) and single-case vs. multiple-case.As I wrote in the title, I'm having trouble understanding the difference between what makes a case study embedded and what makes it a multiple-case design. (2002). In total, 67 projects were approved by the NIHDI, of which 22 were projects with a focus on case management. Article  This paper describes the empirical, theory-driven elaboration of this grid. Scaling ADLs within the MDS. Schafer I. The following step included a between-cases analysis of the projects, trying to identify the essential components of the projects and of the context in [1] achieving their implementation and [2] being successful in reaching the desired outcomes for the older people. Terms and Conditions, The overall table with 23 components displayed into eight domains or requirements of the CCM, along with an operational definition and criteria used to assess the level of achievement of each component within these domains are provided in the Additional file 1. Typically, case studies combine multiple sources of qualitative and quantitative data, used in a complementary way [23, 27]. The embedded case study design is an empirical form of inquiry appropriate for descriptive studies, where the goal is to describe the features, context, and process of a phenomenon. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Only the modalities showing the best quality of the representation of the factorial axes and those which were the most contributive were retained (i.e. This was observed through formal partnerships with coordination (home nursing agencies) and community agencies (Public Centres for Social Welfare). Moreover, once the care providers have been identified by the beneficiaries, their intervention needs to be integrated, so that it is not overlapping and that one care provider knows and realizes what the other care provider does [6]. The study identified a total of 23 interacting key components. TVD, OS, RR, JoM, AD, SD, PM and JM participated in the multiple, embedded case study. 02 July 2009 Brussels, Federal Public Service Health, Food chain safety and Environment [cited 2013]. There is a common language, which also improves the discussion about the beneficiary and fosters better quality of the care. J Adv Nurs. At the beneficiaries’ level, the monitoring of the care plan was seen as crucial to make sure the current organisation of the care was still adequate and this monitoring should be structurally planned. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. must follow a “replication” design . 2000;29(2):165–72. Finally, the decision process regarding the internal organisation of the project itself should be shared with all the actors of the project, because this was seen as a safeguard for the adequacy of the tailored service design and organisation (e.g. The risk of worsening of this situation in Belgium is high. This led us to view this type of case management as a social strategy, in which the level of integration of the care poorly integrates the clinical components. We defined the case as the relationship between leadership and ‘public service motivation’. Relatives of the impaired elderly: correlates of feelings of burden. In a further stage, the numbers of projects sharing similar response modalities were calculated. Multiple correspondence analysis (MCA) of the responses of the normative grid of case management projects. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. http://www.cmsa.org/PolicyMaker/ResourceKit/AboutCaseManagers/tabid/141/Default.aspx, http://www.ejustice.just.fgov.be/loi/loi.htm, http://www.hoint/healthinfo/survey/SAGESurveyManualFinalpdf2006, http://dx.doi.org/10.1186/s12877-015-0084-2, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12877-015-0069-1. Moreover, to evaluate in how far the different projects contributed to delaying institutionalisation, the NIHDI asked a consortium of universities to evaluate the effectiveness of the projects to delay definitive institutionalisation in nursing homes, to maintain or improve the functional status and quality of life while assessing their cost, for the NIHDI, the older people, and the impact on the burden of their main informal caregiver. Thirdly, although MCA allows the transformation of qualitative information into quantitative data to be used in further analysis, when qualitative variables are transformed into quantitative ones, valuable information may be lost [40]. 1995;50(2):M128–33. Manage cookies/Do not sell my data we use in the preference centre. Each of these regions has separate decision powers and funding systems regarding social care, possibly impacting the embeddedness of case management projects. In other words, if desirable outcomes were to be achieved, what would be the essential components of their projects likely to explain these successes? but also “soft” outcomes, such as enhancing coping skills, access to adequate information and service options. Moreover, (c) because there are currently no standards of practice for case management available in Belgium, the case management programmes differed in size (number of professionals involved and caseload), in location (French speaking, Dutch speaking, German speaking regions of Belgium, each presenting different policies possibly influencing case management implementation), in the profile of the case manager (nurses or non-nurses, sometimes even nursing assistants), the degree of involvement of the primary care agencies (among which the general practitioner (GP)), the use of the results of the comprehensive geriatric assessment, i.e. Multiple-Case Designs If the same study contains more than a single case, it is a multiple-case design Advantages Evidence is considered more compelling Overall study is therefore regarded as more robust Disadvantages Rationale for single-case designs usually cannot be satisfied by multiple cases Can require extensive resources and time The first and second dimensions presented had respectively an eigenvalue of 0.087802 (percentage of total = 28.9 %) and 0.062654 (percentage of total = 21.4 %). BMC Public Health. In a second stage, the threshold was again lowered to 15 % and the responses were grouped by proximity of this most contributive response (feedback to the GP; “fban”), in Fig. Google Scholar. Basingstoke Palgrave Macmillan (February 4, 2013); 2013. p. 1–416. This avoided a projection of the typology of projects from a priori ideas [31]. Scores range from 0 to 3. We observe this general trend in home care: people ask to pare the number of care hours. In: Thousand O, SAGE Publications. Khanassov V, Vedel I, Pluye P. Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model. The multiple case studies were performed by a multidisciplinary team of five researchers with a background in public health, sociology, nursing and occupational therapy (OS, MLH, PM, SD & TVD). Privacy Lancet. They say: “You’ll only have to come once per week.” Or “Come one hour less.” I don’t think this is specific for any type of care.” (Interview3 case manager, 2012). BMC Health Serv Res. Burrows AB, Morris JN, Simon SE, Hirdes JP, Phillips C. Development of a minimum data set-based depression rating scale for use in nursing homes. Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting. Int Psychogeriatrics / IPA. Int J Epidemiol. Lee DT, Mackenzie AE, Dudley-Brown S, Chin TM. external, like changes in partnership, or internal, like turnover of professionals etc. In other words, projects attributed to a given type can show response modalities occurring in other types. This monitoring should also occur in other domains, such as monitoring of vital or clinical parameters (e.g. J Gerontol A BiolSci MedSci. The single case study is the most basic form of case-oriented research, but researchers may also conduct a series of case studies, each study building on the previous, or conduct simultaneous studies of several instances of the same phenomenon (as in comparative research). Because case management programmes occur in complex and heterogeneous, multi-layered contexts in which they are embedded and with which they interact, the evaluation of the impact of these programmes needs to take into account these interactions. 1994;22(3–4):143–56. In order to be able to evaluate the 22 case management projects, a maximum of four levels of was provided for each of the 23 components. CA2009. Age Ageing. There is a sense of continuity of the care, a structural support”. TVD performed the multiple correspondence analyses. Firstly, the sample limited to Belgian context calls for warnings about the transferability of the results of the grid and the typology coming out of the MCA in other countries. 2004;4:e10. This was illustrated by a project in their initial submission file: “Our registry can be seen as the brain of the organisation of the care. xxv. 1980;20(6):649–55. Newbury Park: Sage Publications. 2010;12(5):1–266. Springer Nature. An embedded case study is a case study containing more than one sub-unit of analysis (Yin, 2003). Somme D, Trouve H. Dram‚ M, Gagnon D, Couturier Y, Saint-Jean O. In embedded-single case designs, there are more than one sub-unit of analysis. These projects met at least four of six of the elements of the Case Management Society of America’s (CMSA) definition of case management [10]. Moreover, these projects are characterised by a very high turnover rate of the case (tur1) and reportedly insufficient adequacy of the inclusion criteria (ade0). What is Embedded Case Study 1. This classification makes the distinction between three models, [1] the brokerage model, in which advocacy is an important component and the case manager acts as an independent agent; [2] the social entrepreneurship model, where the case manager holds a budget for the purchase of care packages and [3] the extension of the keyworker/care coordinator function in which members of a multidisciplinary team deliver, coordinate and monitor the care provided. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. It has to be stressed that the aforementioned monitoring cannot take place without the close involvement of the frail older people’s primary care physician, who should agree with what has to be monitored and when, in order to be able to link these functions of case management adequately with the other functions of case management. This page was last edited on 8 October 2020, at 11:02. In this study, Coursera-style xMOOCs constitute the main unit of analysis, while Conole’s 12 dimensions constitute the sub-units of analysis. We purposefully selected two Belrhiti et al. The process resulted in a list of 23 components, which were then displayed along with Wagner’s Chronic Care Model [30]. These results were validated by the stakeholders of the 16 projects which were not part of the case studies during yearly focus groups. PubMed  2007. Eventually, in the third type of case management with a more clinical focus, the level of collaboration with other professionals is facilitated by external factors, such as formal agreements with other primary care agencies, the use of software for the organisation of the care, including sharing the information about the beneficiaries with other professionals. The responses are grouped around the most contributive responses. An essay on my car, college essay edit write an essay on intellectual freedom. Similar to a case study, an embedded case study methodology provides a means of integrating quantitative and qualitative methods into a single research study (Scholz & Tietje, 2002; Yin 2003). For our cases, ... and two embedded case studies (mini-cases). Roland W. Scholz suggests that “case is faceted or embedded in a conceptual grid” which allows to identify key components of human and environmental systems (Scholz 2011, p. Rev Epidemiol Sante Publique. BMJ. 2013;25(5):9. Results were then compared and discussed until consensus was reached. More can be added if there is time to process the data. "The case study is preferred in examining contemporary events, when the relevant behaviours cannot be manipulated" (Yin, 2003, p. 7). Frail older people often suffer from multiple, interacting morbidities and incapacities. PLoS One. The collaboration is also facilitated by internal factors, such as the professional skills of the case managers, supported, by former experiences regarding geriatric care and ongoing reflective discussions among peers. http://www.theaudiopedia.com What is EMBEDDED CASE STUDY? In the strengths model, self-determination of the client and assisting the client in attaining client-specific goals are the core task of the case manager instead on basing his support on beneficiaries’ needs. All authors reviewed and approved the final version of the manuscript. On the other hand, inadequate financing of the project, because of over-or more frequently, underestimation of the financial cost of staff, could lead to having to accept higher workloads. https://en.wikipedia.org/w/index.php?title=Embedded_case_study&oldid=982473564, Creative Commons Attribution-ShareAlike License. This enabled the elaboration of a multimodal normative analysis grid, which can be used in evaluation research to make explicit important interacting components of newly implemented case management projects in primary healthcare systems and trigger discussion among stakeholders. A satisfactory approximation of a type was provided if projects were grouped that shared at least the half of the maximum response modalities of their type [32]. Their funding therefore depended on the achievement of their expected caseload as described in the submission files. They are graded from one to three and can be seen as a continuum, going from “social” case management towards “clinical” case management. 2013. Thérèse Van Durme. The modalities of the variables are represented on a graph in function of their coordinates on the two main first dimensions. They dealt with the implementation process of the project, including the description of the differences between the “model” of the project as planned and the project as implemented in practice. These desired outcomes aimed at by the projects could be so-called “hard” outcomes (i.e. Therefore, communication flow between professionals about the beneficiaries’ complex health care needs is likely to be more fluent than in the previous group [45]. It is a simplification of the reality. Brazil AIDS Care. Teachers' Understanding and Use of Formative Assessment Strategies: A Multiple Embedded Case Study in K-12 Urban Ring Schools of a Mid-Size City in Rhode Island Frey, Caroline Adams ProQuest LLC , Ed.D. Lancet. Plsek P, Greenhalgh T. The challenge of complexity in health care. As in many high-income countries, the Belgian healthcare system is considered to be complex for people who need long term care [1]. The response modalities were provided in the close vicinity of the first response modality chosen, reflecting an attraction between these responses in the multiple component analysis. Moreover, as the case manager is to be the reference person for the frail older person, a low turnover rate of case managers was seen as a pivotal component. The principal inertia was rather low, i.e. Pawson R, Tilley N. Realistic Evaluation. Available from: ftp://ftp.hrsa.gov/hab/Typology.pdf. Because of this, there is a need in future research to explicitly take into account the training received by case managers, the experiences and specific functions of case managers, the modes of contact (clinic visits, home visits, telephone calls), the average caseload, the relationship to other health care providers, the use of protocols, guidelines, and information technology ([43],p.16). George A, Bennett A. psychologists or occupational therapists; n = 5 or 23.8 %). IntJ Integr Care. Beardshaw V, Towell D. Assessment and Case Management: Implications for the Implementation of Caring for People. The main outcomes under study were the delay of permanent institutionalisation, maintaining or improving physical functioning (ADL [15], IADL [16]), cognitive functioning (CPS [17]), depressive status (DRS [18]), quality of life [19] and the informal caregivers’ perceived burden [20].The overall design of the evaluation is detailed elsewhere [21]. (Project questionnaire, 2013). They allowed for the standardised collection of data from the six cases by the five researchers involved in the process. The 22 case management projects showed some similarities, as all case managers in the projects were working as a team. Other projects adapted their inclusion or exclusion criteria to the demands of the potential clients and referrers. The evaluation of the effectiveness of complex interventions, such as case management, calls for innovative study designs [36]. delaying institutionalization, improving functional status and health, alleviating the burden of their informal caregivers, etc.) Clin Interv Aging. On each of the axes it is then possible to view the modalities of which the contribution to the formation of the axis is higher than the mean. Keywords: case study; sampling; qualitative sample 1. The teams consisted of (a) only nurse case managers (n = 7; i.e. & Asner-Self, 2011). chronic heart failure), depression symptoms, etc. A project of case management was assigned to a given type if it shared at least half of the response modalities of that particular type [32]. Google Scholar. Three types of projects could be identified, and they are grouped here by the type of response provided to each of the criteria. All members of the project encode their appointments with beneficiaries and it is accessible through VPN”. Scholz, R. W. & Tietje, O. As such it is an important step to allow further impact evaluation, using these types for stratification while fostering discussion among stakeholders. Embedded Case Study Methods: Integrating Quantitative and Qualitative Knowledge. The threshold was augmented until the single most contributive response was identified, i.e. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case … Secondly, key components of case management are listed. Amongst these, the projects identified nine desired outcomes of case management for frail older people, such as (a) improved health and healthcare literacy (including about the project’s functioning); (b) older people’s, informal and professional caregiver’s satisfaction with care; (c) care providers and frail older peoples’ facilitated access to the relevant information; (d) better detection and anticipation of crisis situations; (e) lower threshold for help-seeking behaviours; (f) increased sense of security; (g) decreased sense of social isolation; (h) increased sense of belonging to a community and (i) increased coping abilities and sense of control. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. 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