EANS Summer Exhibition - Case Management and Spouses

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1 DEVELOPING THE SICAM-TRIAL USING MIXED METHODS Connie Bøttcher Berthelsen, MScN, PhD. Clinical Nurse Specialist, Post doctoral fellow, Orthopaedic Department Regional Hospital of Køge, Denmark For the EANS Summer Conference, June 4th

Clinical Nurse Specialist, Post doctoral fellow, Orthopaedic

2 PROJECT MEMBERS OF THE SICAM-TRIAL Project manager: Connie Bøttcher Berthelsen, Project members: Kirsten Frederiksen, MEd, PhD, Faculty of Health Science, Aarhus University, Denmark Tove Lindhardt, MScN, PhD, Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark Bibi Hølge-Hazelton, Associate Professor, PhD, Department of Public Health, Copenhagen University, Denmark Jimmie Kristensson, Associate Professor, PhD, Faculty of Medicine, Lund University, Sweden 2

Copenhagen University Hospital, Herlev, Denmark Bibi Hølge-Hazelton, Associate Professor, PhD, Department of Public

3 THE OBJECTIVES OF THE SICAM-TRIAL To develop, implement, and evaluate a complex intervention of spouses involvement through case management in fast-track treatment programmes, to increase the post-discharge functional status of older patients after total hip replacement. 3

management in fast-track treatment programmes, to increase the

4 THE FOUR PHASES OF THE MRC-FRAMEWORK Craig P, Dieppe P, Petticrew M, et al. (2008) 4

5 THE DEVELOPMENT PHASE OF THE SICAM-TRIAL 1. An arching grounded theory of the pattern of behaviour among relatives, patients, and health professionals, when relatives are involved in older patients fast-track treatment programmes during hip or knee replacement. (Developing theory) 2. Conducting a systematic review of how spouses are involved in older patients care through case management, focusing on intervention process and outcomes. (Identifying the evidence base) 5

relatives are involved in older patients fast-track treatment programmes during hip or knee replacement.

6 BACKGROUND total joint replacements a year in Denmark 50%of patients are above 70 years of age Same discharge criteria as traditional care but systematic optimizing of care reduces length of stay High patient satisfaction and overall effectiveness Clinical pathways for daily standardises schedules Relatives could be an essential support Kehlet H, Wilmore DW (2005, 2008), Hawker, GA. (2006), Ethgen, O, Bruyere, O, Reginster, JY, et al. (2007), 6

as traditional care but systematic optimizing of care reduces length of stay High patient satisfaction and

7 BACKGROUND Relatives often play a substantial role as caregivers and a buffer against stress Improvements in patients stress, depression, pain, anxiety and decrease in length of stay Allen D 2000, Waters K, Allsopp D, Dennis, A. 2001, Craddock AE 1996, Mitchinson AR, Kim HM, Geisser M, et al. 2008, Prouty A, Cooper M, Thomas P, et al. 2006, Theiss, MM, Ellison, MW, Murphy, VJ, et al. 2011, 7

8 THREE GROUNDED THEORIES Relatives, patients, and health professionals pattern of behaviour, respectively, in relation to the relatives of older patients fast-track treatment programmes during total hip or knee replacement Glaserian grounded theory approach 67 participants included Relatives (n=7), patients (n=16), health professionals (n=44). Data was collected in two orthopaedic wards in Danish university hospitals between 2010 to 2011 Glaser BA (1978, 1998) 8

Glaserian grounded theory approach 67 participants included Relatives (n=7), patients (n=16), health professionals

9 THE THEORIES SHOWED Relatives played an important role for the patients by protecting, substituting and adapting Spouses was autonomous together while single patients claimed their independency Health professionals accepted relatives who adhered to the standard principles of the programme and excluded those who disobeyed 9

single patients claimed their independency Health professionals accepted

10 DECIDING TO MODEL AN INTERVENTION Exploratory triangulation mixed methods Arching grounded theory Systematic review Complex intervention 10

11 CASE MANAGEMENT A collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s holistic needs through communication and available resources to promote quality cost-effective outcomes ( 11

individual s holistic needs through communication and available

12 CASE MANAGEMENT Case management has: been applied with success to patients in complex settings Björkman T, Hansson L, Sandlund M. (2002), Harvey K, Burns T, Fahy T, et al. (2002), Rosen A, Teesson M. (2001), Van Achterberg T, Stevens FCJ, Philipsen H, et al. (1996), Rosemann T, Joos, S, Szecsenyi, J, et al. (2007), Schifalacqua M, Hook M, Schmidt M, et al. (2000), Kristensson J, Ekwall AK, Hallberg IR, et al. (2010), Gensichen J, Beyer M, Muth C, et al. (2006), Landi F, Onder G, Bernabei R, et al. (2001). 12

(1996), Rosemann T, Joos, S, Szecsenyi, J, et al. (2007), Schifalacqua M, Hook M, Schmidt M, et al.

13 CASE MANAGEMENT Case management has: been applied with success to patients in complex settings concluded effectiveness of patients quality of life, general satisfaction, depression, functional dependency, length of stay and cost effectiveness Björkman T, Hansson L, Sandlund M. (2002), Rosen A, Teesson M. (2001), Rosemann T, Joos, S, Szecsenyi, J, et al. (2007),Kristensson J, Ekwall AK, Hallberg IR, et al. (2010), Gensichen J, Beyer M, Muth C, et al. (2006), Landi F, Onder G, Bernabei R, et al. (2001), Bernabei R, Landi F, Carbonin PU, et al. (1998). 13

(2002), Rosen A, Teesson M. (2001), Rosemann T, Joos, S, Szecsenyi, J, et al. (2007),Kristensson J, Ekwall AK, Hallberg IR, et al.

14 CASE MANAGEMENT Case management has: been applied with success to patients in complex settings concluded effectiveness of patients quality of life, general satisfaction, depression, functional dependency, length of stay and cost effectiveness Total joint replacement trajectories evaluated to be an ideal setting for successful patient outcome through family education Madrid C. (1994) 14

functional dependency, length of stay and cost effectiveness Total joint replacement

15 OBJECTIVES OF THE SYSTEMATIC REVIEW Baseline knowledge of strengths and weaknesses of case management interventions Identifying, appraising and synthesising literature on case management interventions for spouses Dissemination of intervention Primary outcomes Effect of intervention 15

synthesising literature on case management interventions for spouses

16 THE BENEFITS OF USING MIXED METHODS Providing a better understanding of research problem Model the process and outcomes relevant for older patients and their spouses in orthopaedic fast-track treatment programmes 16

process and outcomes relevant for older patients and

17 THANK YOU 17

18 REFERENCES Allen, D. Negotiating the role of expert carers on an adult hospital ward. Sociology of Health and Illness 2000, 22. Bernabei R, Landi F, Carbonin PU, et al. Randomised trial of impact of model of integrated care and case management for older people living in community. British Medical Journal 1998;316: Björkman T, Hansson L, Sandlund M. Outcome of case management base don the strengths model compared to standard care. A randomised controlled trial. Social Psychiatry and Psychiatric Epidemiology 2002;37: Craddock, AE. Relational resources as buffers against the impact of stress: A longitudinal study of seminary students and their partners. Journal of Psychology and Theology 1996;24: Craig P, Dieppe P, Petticrew M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 2008;337:a1655. Ethgen, O, Bruyere, O, Reginster, JY, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature 3. Journal of Bone and Joint Surgery Am 2007;86-A:

Outcome of case management base don the strengths model compared to standard care. A randomised controlled trial. Social Psychiatry and Psychiatric Epidemiology 2002;37:147-152. Craddock, AE.

19 REFERENCES Gensichen J, Beyer M, Muth C, et al. Review: case management in primary health care improves symptoms and drug adherence in people with major depression. Psychological Medicine 2006;36:7-14. Glaser BG. Theoretical sensitivity. The Sociology Press, University of California, San Fransisco, Glaser BG. Doing grounded theory: Issues and discussions. The Sociology Press, University of California, San Fransisco, Hallberg IR, Kristensson J. Preventive home care of frail older people: a review of recent case management studies. International Journal of Older People Nursing 2004;13: Harvey K, Burns T, Fahy T, et al. The effect of intensive case management on the relatives of patients with severe mental illness. Psychiatric Services 2002;53: Hawker, GA. Who, when, and why total joint replacement surgery? The patient's perspective. Current Oppinion in Rheumatology 2006;18: Intagliata J. Improving the quality of community care for the chronically mentally disabled: the role of case management. Schizophrenia Bulletin 1982;8:

The Sociology Press, University of California, San Fransisco, 1998. Hallberg IR, Kristensson J. Preventive home care of frail older people: a review of recent case management studies.

20 REFERENCES Kehlet H, Wilmore DW. Fast-track surgery. British Journal of Surgery 2005; 92: 3-4. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Annals of Surgery 2008; 248: Kristensson J, Ekwall AK, Hallberg IR, et al. Case managers for frail older people: a randomised controlled pilot study. Scandinavian Journal of Caring Science 2010;24: Landi F, Onder G, Bernabei R, et al. A new model of integrated home care for the elderly: impact on hospital use. Journal of Clinical Epidemiology 2001;54: Madrid C. Orthopedic case management in a collaborative practice setting. Seminar for Perioperative Nursing 1994;3: Mitchinson AR, Kim HM, Geisser M, et al. Social connectedness and patient recovery after major operations. Journal of the American College of Surgeons 2008; 206:

Scandinavian Journal of Caring Science 2010;24:755-763. Landi F, Onder G, Bernabei R, et al. A new model of integrated home care for the elderly: impact on hospital use.

21 REFERENCES Prouty A, Cooper M, Thomas P, et al. Multidiciplinary patient education to total joint replacement surgery patients. Orthopaedic Nursing 2006;25: Rosemann T, Joos, S, Szecsenyi, J, et al. Case Management of Arthritis Patients in Primary Care: A Cluster-Randomized Controlled Trial. Arthritis Care and Research 2007;57: Rosen A, Teesson M. Does case management work? The evidence and the abuse of evidence-based medicine. Australian and New Zealand Journal of Psychiatry 2001;35: Schifalacqua M, Hook M, Schmidt M, et al. Coordinating the Care of the Chronically Ill in a World of Managed Care. Nursing Administration Quarterly 2000;24: Theiss, MM, Ellison, MW, Murphy, VJ, et al. The Connection Between Strong Social Support and Joint Replacement Outcomes. Orthopaedics 2011;34: Van Achterberg T, Stevens FCJ, Philipsen H, et al. Coordination of care: effects on the continuity and quality of care. International Journal of Nursing studies 1996;33:

22 REFERENCES Waters, K, Allsopp, D, Dennis, A. Sources of support for older people after discharge from hospital: 10 years on. Journal of Advanced Nursing 2001;33:

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