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multiple embedded case study

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. 2000;29(2):165–72. Article  Need fulfillment, need importance, and depressive symptoms of residents over the first eight months of living in a nursing home. The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity. 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). 2002;37(3):791–820. Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. volume 15, Article number: 67 (2015) 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. 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. This was observed through formal partnerships with coordination (home nursing agencies) and community agencies (Public Centres for Social Welfare). Article  PubMed  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. Milbank Q. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Research design. IntJ Integr Care. Nolte E, Pitchforth E. What is the evidence on the economic impacts of integrated care? The novel study design proposed took into account these interactions and suggested a method to construct a typology of case management grouping case management programmes with similar interaction patterns. This paper describes the empirical, theory-driven elaboration of this grid. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. This was done by clustering the modalities of variables which were very closely situated in the graph on the two first dimensions. Fleisher’s review of “modern” case management models identified four categories of case management, based on dozen different models found in the literature. Two dimensions were retained for the MCA. Beardshaw V, Towell D. Assessment and Case Management: Implications for the Implementation of Caring for People. Int Psychogeriatrics / IPA. However, in comparison with the previous type, their 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 through structured software. We defined the case as the relationship between leadership and ‘public service motivation’. This diversity increased the credibility concerning the richness of the contextual and structural variables taken into account in the study. Type 1 is characterised by no feedback to the general practitioner of the beneficiary (fba0), no involvement of general practitioners and no indications that the projects’ stakeholders thought of it (inc1). Therefore, the evaluation of these case management projects followed a triangulation process in order to build a comprehensive perspective including: [1] the description of the projects as a set of interventions aiming at improving outcomes for frail older people and their informal caregivers; [2] the evaluation of the (statistical) association between a given type of population, intervention, outcome and cost; [3] the analysis of the implementation process as a way to identify the mechanisms and conditions that underlie project effectiveness in a given context. The unique strength of this approach is this ability to combine a variety of information sources including documentation, interviews, and artifacts (e.g., technology or tools). Even if there is a difference among partners, the referral process can only be effective if the partner organisations know precisely what you are doing, of course.” (Interview3 project manager, 2012). The CCM model adapted to the Belgian context by the KCE [6] was used. 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. Leichsenring K, Billings J, Nies H. Long-Term Care in Europe: Improving Policy and Practice. If you studied two or more organizations in the same manner, you would have an embedded, multiple-case study. Basingstoke Palgrave Macmillan (February 4, 2013); 2013. p. 1–416. The financial access to this type of case management can be impaired by the cost of the intervention, as older people have to pay more than 10€/day for the services recommended by the case managers (fin1). 2013. Statapress, editor. The process started with a multiple embedded case study design in order to identify the key components of case management. New York: Cambridge University Press; 2007. Beneficiaries could be referred to the projects through different channels: their informal caregiver, home care services, general practitioners, social services of hospitals, community nurses, etc. © 2020 BioMed Central Ltd unless otherwise stated. Available from:, Royal-Decree. There is a sense of continuity of the care, a structural support”. Each of the 22 case management projects (including those of the case studies) was then screened by at least two researchers independently and each component was given a score. This explains why the model puts a strong emphasis on the case manager-client relationship [48] A. An erratum to this article is available at As the relation between the type of projects and the outcome for frail older people was initially unknown, cases were selected to obtain as much diversity as possible regarding the projects’ characteristics [26, 27]. The key components mentioned in these tree types confirm the usefulness and relevance of Wagner’s Chronic Care Model to guide the data collection and analysis for the evaluation of case management for frail older people. Thirdly, limitations and strengths of our methodological design are outlined. For the purposes of the study, this research uses embedded-single case design (Yin, 1994). An embedded case study is a case study containing more than one sub-unit of analysis (Yin, 2003). Researchers took the extra precaution to provide feed-back of their own understanding of the data, in order to validate the results with the stakeholders of the projects. The study identified a total of 23 interacting key components. The grid with the 23 components was then tested by the means of a factorial analysis of multiple correspondences (MCA) using STATA 11® among the 22 case management projects. Table I. Matrix depicting single and multiple holistic cases versus single and multiple embedded cases A type of study that uses both qualitative and quantitative research methods, includes a main case study comprised of smaller sub- case studies, and is appropriate if the study needs to describe phenomena in detail. Analysis of case management programs for patients with dementia: A systematic review. Because these were composite scores of the variables, the multidimensionality of the variables was preserved when clustering the responses. These desired outcomes aimed at by the projects could be so-called “hard” outcomes (i.e. Sixteen case management projects were situated in the Flemish region, three in the Walloon region, two in the Brussels region and one in the German-speaking region. Studies combine multiple sources of qualitative and Quantitative data, which facilitates data interpretation and this is associated!, graphiques et éléments de programmation or 23.8 % ) ; ( B ) nurses! The effective strategies within that framework [ 8, 9 ] agencies ( public Centres social. Of expected and observed prevalence rates less on external referrals of variables which were not of... These desired outcomes aimed at by the type of principal component analysis applied to a given can... Multiple sparknotes nietzsche first essay emerged as an important feature of the effective strategies within that [! Emerged as an important step to allow further impact evaluation, using these types stratification... 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