Implementing a case management program designed to enhance primary care physician practice with older persons

A qualitative analysis of the implementation of a case management program i s presented This collaborative research design uses semistructured intervie ws and observational field methods. Nested within a changing health care en vironment and a corporation that is restructuring three physician practices form the intervention sites. During the course of the project there is hig h turnover among project staff and physicians. This analysis begins with th e intervention in which case managers mobilize resources, monitor medicatio n and health care compliance, educate elderly participants and physicians, counsel participants, and provide caregiver support and follow-up. Adjustin g to and defining the case management role, structuring supervision and nur turing the intervention, and communicating (both written and face-to-face) with diverse physicians are ongoing tasks throughout project development. T he importance of clear communication, the need for great flexibility, and t he search to maintain project integrity (keeping sight of the intervention) emerge as critical themes.