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

<h3>Purpose</h3><p>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<p><p>estimate the relative importance of these direct and indirect effects of variations in case management inputs.

<p><p><h3>Methods</h3><p>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<p><p>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.

<p><p><h3>Inputs</h3><p>Estimates of direct and indirect effects in the PSSRU experiments are also made with a multiple equation cost function.

<p><p><h3>Results</h3><p>Indirect effects were significant (p=.007) inchanneling. The equation yields direct estimates of the marginal<p><p>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.,