Using concept analysis to define the role of medical case management

Background: HIV case managers are the primary point of access to HIV care and are a critical link in patient retention. The delivery of HIV case management, also distinguished by Health Resources and Services Administration (HRSA) as medical and non-medical, is influenced by staff qualifications and competencies, proximity to a primary HIV care facility and level of patient need. While the practice has been delineated on a federal level, state and local health departments are challenged with further defining and refining the roles and responsibilities associated with each case management type. The lack of a conceptual definition, standardization of roles and responsibilities, and clearly described competencies has resulted in service duplication and lack of patient care coordination. Methods: A multi-disciplinary team of local and state health department administrators and case management staff conducted a comprehensive review of case management standards of care and scopes of work from five Ryan White Part A grantees and evaluated several existing case management knowledge and skills assessment surveys. Recurring competencies and skills were used to develop a survey that was specific to the local case management agencies. Results from the surveys were used to identify training and capacity building needs and all case managers participated in a two-day training that was facilitated by a HRSA case management expert. Themes identified during the comprehensive review of existing standards and competencies were then incorporated into existing job descriptions and used as a framework to develop standards of care. Results: Upon completion of the concept analysis and comprehensive review of case management practices, the local and state health department administrators were able to restructure job descriptions, define the scope of case management practice, develop case management standards of care and measures to monitor the quality of service delivery. Conclusions/Implications: Establishing a conceptual definition, core competencies and roles and responsibilities for case management has implications for systems of care and fiscal management. Defining the scope of practice for each case management category can reduce duplication of services, improve patient care coordination, promote patient self-disease management and assist Ryan White grantees in efficiently managing their grants.