Evaluating case management as a complex intervention: Lessons for the future

Autoři: Anne-Sophie Lambert aff001;  Catherine Legrand aff002;  Sophie Cès aff001;  Thérèse Van Durme aff001;  Jean Macq aff001
Působiště autorů: Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium aff001;  Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA-IMMAQ), Université Catholique de Louvain, Louvain-la-Neuve, Belgium aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224286


The methodological challenges to effectiveness evaluation of complex interventions has been widely discussed. Bottom-up case management for frail older person was implemented in Belgium, and indeed, it was evaluated as a complex intervention. This paper presents the methodological approach we developed to respond to four main methodological challenges regarding the evaluation of case management: (1) the standardization of the interventions, (2) stratification of the frail older population that was used to test various modalities of case management with different risks groups, (3) the building of a control group, and (4) the use of multiple outcomes in evaluating case management. To address these challenges, we developed a mixed-methods approach that (1) used multiple embedded case studies to classify case management types according to their characteristics and implementation conditions; and (2) compared subgroups of beneficiaries with specific needs (defined by Principal Component Analysis prior to cluster analysis) and a control group receiving ‘usual care’, to evaluate the effectiveness of case management. The beneficiaries’ subgroups were matched using propensity scores and compared using generalized pairwise comparison and the hurdle model with the control group. Our results suggest that the impact of case management on patient health and the services used varies according to specific needs and categories of case management. However, these equivocal results question our methodological approach. We suggest to reconsider the evaluation approach by moving away from a viewing case management as an intervention. Rather, it should be considered as a process of interconnected actions taking place within a complex system.

Klíčová slova:

Activities of daily living – Behavior – Cognitive impairment – Complex systems – Critical care and emergency medicine – Depression – Frailty – Long-term care


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