Funded projects

Government policy has suggested that nurses should play a greater role in helping people manage their chronic medical conditions. The majority of people with chronic, long term conditions manage their own condition however when ...

Government policy has suggested that nurses should play a greater role in helping people manage their chronic medical conditions. The majority of people with chronic, long term conditions manage their own condition however when the condition is more complicated, or additional medical problems occur, medical and health personnel from both the surgery and the hospital become more involved in their treatment. There is a small group of people with long term conditions who have complex medical and social care needs. It is thought that this group benefit when one member from the health team is given the responsibility for ensuring the co-ordination of that persons care: This person is called a care manager or a key worker. It is not clear to what extent nurses are taking these roles, what assists or detracts from them taking these roles and what impact it has for service users and service delivery if they take these roles. This study is designed to answer those questions by:1. A critical integrative review of the policy literature and research evidence 2. Surveying senior managers in up to 100 health organisations by postal questionnaire with follow up telephone calls whether and in what nurses are taking these roles3. Undertaking a comparative study with 12 nurses undertaking case management roles in different ways with people in LTC in three health care organisations in different parts of the country. We will follow up the health and social care received by 20 people with LTC over 9 months. We will compare and contrast the experience of the people with LTC, the factors that support and inhibit the nurses taking case management roles and the cost consequences of different models for the patients and the health and social care services. This study will provide professionals, managers and lay people who provide, and commission health and social care services with information about the contribution of nurses on which to make decisions as they improve and reshape services for people with long term conditions

Government policy has suggested that nurses play a greater role than before in the health service response to people with long term conditions (LTC) and in particular in assuming the case management role. This is ...

Government policy has suggested that nurses play a greater role than before in the health service response to people with long term conditions (LTC) and in particular in assuming the case management role. This is attributable to increasing numbers of people requiring sustained and co-ordinated care for their LTC, an environment of changing health and social care labour markets, an increasing diversity of health and social care provision and greater patient/user choice. This study is designed to inform those engaged in decision making for service organisation and delivery. It will enable them to determine the extent and impact of NMHV working as case managers within different models of care delivery on patients and service utilisation and its place within complex health and social care networks. Specifically the study objectives are: - Identify the drivers that have stimulated the development of models of chronic disease management that involve NMHV and map their development over time.- Describe the range and type of chronic disease models and the ways that they involve service users and carers. - Describe and classify the roles and responsibilities of NMHVs in current models of chronic disease management.- Evaluate the impact of NMHVs contribution to the experiences of patients, service users, professionals and carers.- Identify the factors that enable NMHVs to contribute most effectively to successful outcomes of care- Identify the factors that sustain the models of care over time.- Describe the mechanisms that are used for knowledge transfer and enhance learning between all members of the care team and the wider organisation.- Evaluate the impact of the NMHV contribution upon the cost, quality, effectiveness and organisation of the care provided.The study is designed in two phases with phase one informing the case selection within phase two.Phase one:1. National overview (macro level analysis): Review of policy and research on NMHV contribution to LTC.2. Service Organisation and implementation (meso level analysis) A scoping exercise of key informants from up to 100 NHS trusts and Local Health Boards across England and Wales to survey and establish how the nursing contribution to long term care has been interpreted and implemented. The combined findings from phase one addresses objectives 1,2,3,4,5,8 informs the framework for phase two and will provide a classification of different models of care delivery that involves nursing, their origins, sustainability, evidence base and how they have been implemented across England and Wales. Phase two:3. User experience and outcomes (micro level analysis): Drawing on the principles of realist evaluation and using an in depth comparative case study design we will study prospectively over 9 months the patient experience (n=20) and nursing contribution (n=12) within four different models of care delivery for LTC that are provided in three separate Trusts. We will address objectives 4, 5, 6, 7, 8.by comparing and contrasting the experience of the people with LTC, the factors that support and inhibit the nurses taking case management roles and the cost consequences of different models for the patients and the health and social care services. The policy and research review combined with the evaluation of four different models of care delivery in three different settings will give service commissioners, providers, practitioners and users evidence as a basis for decision making about the nursing contribution as they improve and reshape services for people with long term conditions.

1: Gage, H; Ting, S; Williams, P; Drennan, V; Goodman, C; Iliffe, S; Manthorpe, J; Davies, SL; Masey, H; Scott, C; Brearley, S. Commissioning nurse led case management for community dwelling older people: ...

1: Gage, H; Ting, S; Williams, P; Drennan, V; Goodman, C; Iliffe, S; Manthorpe, J; Davies, SL; Masey, H; Scott, C; Brearley, S. Commissioning nurse led case management for community dwelling older people: comparison of models and costs. British Journal of General Practice 2010;61(591):658-665
2: Drennan, V; Goodman, C; Manthorpe, J; Davies, S; Scott, C; Gage, H; Iiffe, S. Establishing new nursing roles: a case study of the English community matron initiative. Journal of Clinical Nursing 2011
3: Manthorpe J, Goodman C, Drennan V, Davies S, Masey H, Gage H, Scott C, Brearley S, Iliffe S.. Nurse-led case management in the NHS: bridging clinical and social worlds?. Primary Health Care Research & Development 2011;13: 153164
4: Ilife, S; Drennan, V; Manthorpe, J; Gage, H; Davies, SL; Massey, H; Scott, C; Brearley, S; Goodman, C. Nurse case management and general practice: implications for GP consortia. British Journal of General Practice 2011;61(591):e658-e665(8)