Linklng guidelines for case management to risk of institutionalization.

In this study, we developed time-and-need-based community case management guidelines by tracking case management activity for 234 elderly clients over their first 6 months of care. Clients were interviewed at the time services began and again 6 months later to determine physical, emotional, and cognitive status. We found that the Regina Risk Indicator Tool (RRIT), a brief measure of risk for requiring institutional care, differentiated clients needing varying amounts of case management. Using these results, an expert panel devised guidelines for ranges of case management time for clients at different levels of need: low risk, some risk, and high risk. Quality measures, response times for initial contact and assessment, and service review parameters were also incorporated into the guidelines. Tools for workload measurement, quality review, client satisfaction, and service provider communication were developed. Focus group analysis of the guidelines with various stakeholders and a pilot implementation guided further revision. Future directions are outlined in the article, including the need to focus on outcomes of the guidelines and study of guideline implementation processes.