How case management confers benefits: estimates of the direct and indirect effects from the channeling, the Kent Community Care Project and its replications

Purpose Case management rationales suggest that its main benefit is indirect: its input making other service inputs more effective. However, case management activity can also have direct effects on outcomes. The purpose of the paper is to estimate the relative importance of these direct and indirect effects of variations in case management inputs. Methods Data: (i) the US long-term care channeling demonstration in 10 sites and 2141 subjects; and (ii) data through time for the experimental groups of the Kent Community Care project and three of its closest English (PSSRU) replications: the Gateshead, Sheppey and Tonbridge programmes. Controlling for site differences in casemix using a 'production function' for the most important indicator of achieving the programme goal (channeling) and cost function for multiple outcomes (PSSRU experiments), model estimates of the indirect effects of variations in case management. Inputs Estimates of direct and indirect effects in the PSSRU experiments are also made with a multiple equation cost function. Results Indirect effects were significant (p=.007) inchanneling. The equation yields direct estimates of the marginal productivity of case management. Indirect effects were complex in the English projects, and the direct effects were stronger than the indirect effects; the opposite of what would be expected from the case management literature.,