Impact of Case Management on Access to Care and Duty Limitation

Case management has been shown to decrease cost, reduce unnecessary utilization, and improve outcomes for patients in many medical settings. A study in the civilian sector by Reiss-Brennan et al.,  retrospectively assessed integrated team-based care (TBC) vs. traditional practice management (TPM). After reviewing 113,452 participants, the authors found lower rates of health care utilization for TBC patients compared with TPM patients for emergency department visits, hospital admissions, ambulatory care sensitive visits and admissions, and primary care physician encounters.

However, to the investigators’ knowledge, case management has not been fully tested and deployed within the MHS to determine if integrated support with case management can decrease duty limitations among ADSM due to MSKI. By translating lessons learned in the civilian medical sector to military medicine, implementation of dedicated case management into MTF clinics or integrated practice units in operational settings can provide coordination of care, which in turn enhances readiness and resilience.

The objective of this comparative-effectiveness study is to determine if integrated support with case management within MTF and operational settings can improve access to care and duty limitation among ADSM with MSKI. investigators will leverage their research operations at operational and MTF settings to identify 12 locations (6 operational, 6 MTF) with matching characteristics (e.g., case load, patient injury profiles). In this proposed comparative-effectiveness study, the operational and MTF locations will be randomized (1:1 operational, 1:1 MTF) to receive immediate case management support (intervention) or standard of care (control) with crossover at 12 months to case management (delayed case management). For 24 months, case managers will engage with patients, providers, and systems (direct and private sector care), for coordination of care, in order to understand the clinical and economic impact of integrated case management in selected clinical settings. Participants for this study will be patients at selected MTFs or operational settings who are receiving care for MSKI, as well as providers caring for patients at these sites. Data collection will include the review of medical records, and completion of patient-reported outcome measures and questionnaires. Providers will also be asked to complete questionnaires related to burnout, quality of life, wellness, and resilience. Outcomes will include trends in access to care (e.g., time from referral to appointment, patient compliance with appointments) with and without case management intervention; number of appointments, emergency department visits, and inpatient admissions; overall duration of duty limitation for ADSM; and measures of burnout, work satisfaction, quality of life, and resilience among providers at the research sites.