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Case management

This page provides information for PCTs and commissioners about case management, and the tools available to support effective implementation of case management.

What is case management?

Case management is a service, led by a community matron or case manager that provides proactive, coordinated care to people who have an intricate mix of health and social care needs.  It provides an intense level of care, preventing people from unnecessary admission to hospital and providing more care in the person’s home or community setting.  It supports carers by relieving them of having to coordinate services and navigate a range of health and social care systems.

Case management was introduced to improve care for vulnerable people who often experience gaps in services and to reduce demand on secondary care services.  It has been driven by the long term conditions PSA target to reduce emergency bed days through improved care.

How is it being implemented?

To implement effective case management, Primary Care Trusts and other commissioners of health and social care services are required to proactively identify the most vulnerable patients with complex, single or multiple long term condition needs who are most at risk of unplanned admission (referred to as “very high intensity users”.) and offer them the case management service.

For case management to be successful, a whole system approach is required.  This means that community matrons and case managers must integrate with other parts of the health and social care system, working alongside GPs and others in the primary health care team as well as local acute trust, mental health care providers and social services, adopting a multidisciplinary team approach.   Teams need to have the appropriate mix of skills to meet the needs of the population of very high intensity users and indeed of other people with long term conditions who require coordinated and seamless care.

Evidence abroad has shown that intensive, on-going and personalised case management for patients with multiple or single complex conditions can improve their quality of life and outcomes, thus dramatically reducing emergency hospital admissions and enabling patients who are admitted, to return home more quickly.  PCTs are encouraged to undertake local  monitoring and evaluation of case management and many are seeing improvements in terms of improvements in care and savings from reductions in emergency bed days.

Patients At Risk of Re-hospitalisation (PARR++)

Patients At Risk of Re-hospitalisation (PARR) Case Finding Tools

As part of the Department of Health's long term conditions strategy, they commissioned the King's Fund and their partners Health Dialog UK and New York Univeristy to develop a software tool for use by Primary Care Trusts (PCTs) to systematically identify patients who are at high risk in the future of readmission to hospital via emergency admissions. The Patients At Risk of Re-hospitalisation (PARR) Case Finding Tool became nationally available from September 2005.

Since then further iterations of the PARR tool have been developed.  The latest version, PARR++ , which was released in November 2007, features a number of upgrades to improve effectiveness such as being more accurate, more user friendly and more flexible in how data is displayed and the reports it can generate. 

PARR++ is free to download from the King’s Fund website and is also available on CDRom by emailing LongTermConditions@dh.gsi.gov.uk.

 The Combined Predictive Risk Model

The Combined Model, also developed by the King’s Fund and their partners on behalf of DH  uses a more powerful combination of hospital and community data to increase predictive power.  As it has an important added benefit of identifying people who have never had an admission but are predicted to be future high users of secondary care services, it means that relevant interventions can be provided at a much earlier stage, improving care for those people and preventing or slowing down deterioration.

Implementation of the Combined Model is more complex than PARR, it is not a software tool but rather s set of techinical information on how to combine information.  It is based on the poplualtion of Croydon, where it was piloted and therefore may need a certain degree of calibration for other PCTS to implement it.  This will require programming and analytic skills.  In addition it needs central data sharing to be effective, however the Combined Model has huge potential  to support better commissioning.

NHS Networks – Risk Prediction Network Forum

In January 2008, we set up a risk prediction network on NHS Networks. The network provides a nationwide forum to engage health and social care groups, including those involved in commissioning, clinicians, community matrons, NHS and social care managers, to share ideas, experiences and knowledge on different methods of predicting and stratifying risk of local health populations.

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