Case Management Completion

Case management is completed when the patient meets a variety of milestones. These milestones may include a combination of direct oversight and regular reviews of the patient's progress with the care continuum specific to the infectious disease.

Clinical improvement, laboratory monitoring, and compliance with an established plan of care can provide clear indicators that case management activities have been successful and may be coming to a close.

Review the examples below.

TB

As previously noted, TB therapy can be as short as six months, or it can be much longer.

Factors that influence the length of therapy include:

  • Site of disease
  • Response to therapy
  • Drug resistance
  • Medication tolerance
  • Adherence to treatment
  • Documented laboratory or radiographic improvement

Collaboration with the clinical team provides incremental evidence of the patient's success with treatment. By meeting regularly with the treatment team, it is easier to see when milestones have been reached.

During the patient's last clinical appointment, the clinical provider will project the last day medications need to be taken. Patients who have completed TB therapy will be given a letter of completion from the clinical provider for their records, and will be instructed to return if TB symptoms recur. 

Perinatal Hepatitis B

Perinatal hepatitis B case management comes to a close once the infant has completed his/her hepatitis B vaccine series and has a blood test (PVST) that shows protection against hepatitis B.

As previously described, PVST should take place once the baby has completed their hepatitis B vaccine series, at 9-12 months of age, and at least 1-2 months after the final dose of vaccine.

If the baby's blood test shows they are HBsAg negative, and anti-HBs positive, then they are considered protected against hepatitis B and case management is complete.

  • Occasionally, PVST results may show that a baby is not protected, and the case manager will follow up with the pediatrician to determine the best course of action

 

Summary

Infectious disease case management is a collaborative process with many partners, components, and activities.

Keeping the patient central in the process, viewing them in a holistic way, ensuring their medical and psycho-social needs are met, and preserving autonomy are the keys to successful case management.