A Comparative Effectiveness Study in Health Care Management of Neurosurgery Patients by Bangkok International Hospital Case Manager Nurse

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Thitaree Yongprawat
Chutikan Suwalapha
Laksamee Jarrat
Nilobol Piewthai
Wirongrong Charoengid
Nanthasak Tisavipat


OBJECTIVES: To compare effective health care management practices, with a focus on three dimensions consisting of internal process, utilization management (UM) and financial management (FM) between patients who received clinical coordination interventions by case management (CM) nurse and usual standard of care of neurosurgery patients at Bangkok International Hospital (BIH).

MATERIALS AND METHODS: This study is a retrospective chart review. This research collected data from neurosurgical patients, namely confirmed cases by neurosurgeons. They have undergone brain surgery procedures and have been admitted to BIH during a period of 3 years from 1st January 2019 - 30th June 2022. We compared the outcome variables between two groups (The control group received usual care and the post-intervention group received clinical coordination by CM nurse) to assess the effectiveness of health care management. This consisted of the internal process, UM and FM. These data were analyzed using statistics with descriptive statistics and the independent t-test.

RESULTS: Of a total of 372 neurosurgical cases, 235 cases (63.2%) met the inclusion criteria. More than half of cases were male (58.3%). The mean age was 60.6 ± 16.6 years. Most of them 181 (77.0%) were admitted to the neuro ward. The diagnosis included Stroke 100 (42.5%), Brain Tumor 86 (36.6%) and Traumatic Brain Injury (TBI) 27 (11.5%), respectively. The post-intervention group presented obviously higher compliance rates of 87.2% with a patient/family care team meeting and 79.2% discharge planning, respectively. The post-intervention group had lower costs (0.1%) of Risk Management than the control group (0.4%). Meanwhile, the control group had lower cost of bad debts expenses per year than the post-intervention group. That may have been an effect of some patients in the post-intervention group not having an insurance coverage of 100% of medical costs and could not afford the care. The comparison of the LoS in the control group showed significant differences, and less than those in the post-intervention group (p < 0.05).

CONCLUSION: These results indicate that CM nurses can decrease risk management costs. Although, this study does have limitations. We have seen a positive trend towards using our CM model as this can assist in the improvement of quality in health care management through an effective care team meeting and discharge planning for our neurosurgical patients and their family. However, future studies should control confounding variables and more study is needed into other factors that may affect clinical outcomes.


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Yongprawat T, Suwalapha C, Jarrat L, Piewthai N, Charoengid W, Tisavipat N. A Comparative Effectiveness Study in Health Care Management of Neurosurgery Patients by Bangkok International Hospital Case Manager Nurse. BKK Med J [Internet]. 2023 Feb. 28 [cited 2023 Mar. 30];19(1):8. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/260856
Original Article


Limpanyalerd P, Wongvichai C, Nakthongkul W. Patient experience: Feedback in a health service quality system [Internet]. Bangkok: The Healthcare Accreditation Institute (Public Organization) 2016. (Accessed August 19,2021, at https://www.hfocus.org).

Kalisch BJ, McLaughlin M, Dabney BW. Patient perceptions of missed nursing care. Jt Comm J Qual Patient Saf 2012;38(4):161-7. doi: 10.1016/s1553-7250(12)38021-5.

Vermeir P, Vandijck D, Degroote S, et al. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract. 2015;69(11):1257-67. doi: 10.1111/ijcp.12686

Case Management Society of America: CMSA. Standard of practice for case management [Internet]. Tennessee: 2016;1- 38. (Accessed August 1,2021, at https://www.cmse.org).

Joo JY, Huber DL. Scoping Review of Nursing Case Management in the United States. Clinical Nursing Research 2017;27(2):105477381771786. doi:10.1177/1054773817717861.

Bamford C., Poole M., Brittain K., et al. Understanding the challenges to implementing case management for people with dementia in primary care in England: A qualitative study using Normalization Process Theory. BMC Health Service Research 2014. Retrieved from http://www.biomedcentral. com/1472-6963/14/549

Klockmo C, Marnetoft SU. (2016). Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system. International Journal of Rehabilitation Research 2016; 39:123-129.

You EC, Dunt D, Doyle C. Influences on case-managed community aged care practice. Qualitative Health Research 2016;26:1649-61.

Chaiyarit A, Jangsombatsir W. Significant roles of nurse case manager to improve quality of care for chronically ill patients: Diabetes and hypertensive patients. Nurs J CMU 2017;44(4):195-205.

Joo JY, Liu MF. Effectiveness of nurse-led case management in cancer care: systematic review. Clin Nurs Res 2019;28(8):968-91. doi: 10.1177/1054773818773285.

Oregon Health & Science University: OHSU. Nurse case management [Internet]. Oregon: 2020. (Accessed August 1,2021, at https://www.ohsu.edu/partnership-project/medicalcase-management-and-intake).

Puwatanasan A, Charoengid W, Suwalapha C, et al. Bangkok International Hospital. Case management Nurse (CM Nurses) 2020. Training paper. Bangkok: Bangkok Hospital Headquarters; 2021 August 9.

Leung A CT, Yau D CN, Liu CP, et al. Reducing utilization of hospital services by case management: a randomized controlled trial. Aust Health Rev;2004;28(1):79-86. doi: 10.1071/ah040079.

Kuehl RO. Design of experiments: statistical principles of research design and analysis. 2000 2nd edition. Duxbury Press, Pacific Grove. California.

Sepucha KR, Fagerlin A, Couper MP, et al. How does feeling informed relate to being informed? The DECISIONS survey. Med Decis Making 2010;30(5 Suppl):77S-84S.doi: 10.1177/0272989X10379647.

Sullivan B, Ming D, Boggan JC, et al. An evaluation of physician predictions of discharge on a general medicine service. J Hosp Med 2015;(12):808-10. doi:10.1002/jhm.2439

Kaipio J, Kuusisto A, Hypponen H, et al. Physicians’ and nurses’ experiences on EHR usability: Comparison between the professional groups by employment sector and system brand. International Journal of Medical Informatics 134 (2020) 104018 from www.elsevier.com/locate/ijmedinf.

Daniel MO, Rosenstein AH. Professional Communication and Team Collaboration. Patient Safety and Quality: An EvidenceBased Handbook for Nurses[Internet]. 2018;2:2-284. (Accessed January 23,2023, at: https://www.researchgate.net/ publication/288658086_Professional_Communication_and_ team_collaboration_patient_safety_and_quality_An_eeidence-Based_handbook_for_nurses.

Panuthai S. Factors affecting readiness for hospital discharge among older persons. Nurs J 2014;41(4):150-60.

Thammarux T, Chanruangvanich W, Thosingha O, et al. Impact of a family-empowering programme on the coping ability of the family caregivers of postoperative neurosurgical patients in a neurosurgical ICU. Thai J Nurs Counc 2017;32(2):49-64.

Roy C, Zhan L. Sister Callista Roy’s adaptation model. In: Parker ME, Smith MC, eds. Nursing Theories and Nursing Practice. 3rd ed. Philadelphia: F.A. Davis; 2010:167-81.

Toole J, Kohansieh M, Khan U, et al. Does your patient understand their treatment plan? Factors affecting patient understanding of their medical care treatment plan in the inpatient setting. J Patient Exp 2020;7(6):1151-7. doi: 10.1177/2374373520948400.

Burgio LD, Collins IB, Schmid B, et al. Translating the REACH caregiver intervention for use by area agency on aging personnel: the REACH OUT program. Gerontologist 2009;49(1):103-16. doi: 10.1093/geront/gnp012.

Toh HJ, Lim ZY, Yap P, et al. Factors associated with prolonged length of stay in older patients. Singapore Med J 2017;58(3):134-8. doi: 10.11622/smedj.2016158.

Valderas JM, Starfield B, MPH, Sibbald B, et al. Defining Comorbidity: Implications for Understanding Health and Health Services. Ann Fam Med 2009;7(4):357-63. doi: 10.1370/afm.983.

Hendy P, Patel JH, Kordbacheh T, et al. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med (Lond) 2012;12(4):320-3. doi: 10.7861/ clinmedicine.12-4-320.

Trevisi G, Scerrati A, Rustemi O, et al. Has the timing of the surgery a major role in influencing outcome in elderly patients with acute subdural hematomas? Medicine & pharmacology, clinical neurology, from https://www.preprints.org 2022. doi: 10.20944/preprints202208.0394.v1.

Chang JK, Calligaro KD, Lombardi JP, Dougherty MJ. Factors that predict prolonged length of stay after aortic surgery. J Vasc Surg 2003;38:335-9.

Purba A KR, Luz CF, Gun L VD, et al. The Impacts of Deep Surgical Site Infections on Readmissions, Length of Stay, and Costs: A Matched Case–Control Study Conducted in an Academic Hospital in the Netherlands. Dove Press journal: Infection and Drug Resistance 2020:13 3365-74.

McPeake J, Bateson M, Christie F, et al. Hospital re-admission after critical care survival: a systematic review and meta-analysis. Anaesthesia 2021;77(4):475-85. doi: 10.1111/ anae.15644.

Wong E, Mavondo F, Fisher J. Patient feedback to improve quality of patient-centred care in public hospitals: a systematic review of the evidence. BMC Health Serv Res 2020;20:530. doi:10.1186/s12913-020-05383-3.

Doshmangir L, Khabiri R, Jabbari K, et al. Strategies for utilization management of hospital services: a systematic review of interventions. Global Health 2022;18:53. doi: 10.1186/s12992-022-00835-3.

Hunter T, Nelson JR, Birmingham J. Preventing readmissions through comprehensive discharge planning. Prof Case Manag 2013;18(2):56-63. doi: 10.1097/NCM.0b013e31827de1ce.

Thomson S, Foubister T, Figueras J, et al. Addressing financial sustainability in health systems. World Health Organization 2009 and World Health Organization, on behalf of the European Observatory on Health Systems and Policies 2009. (Accessed August 19,2021, at https://www.euro.who.int/__ data/assets/pdf_file/0005/64949/E93058.pdf 1-49.).

Ankush B, Rahul S, Elaina W, et al. Cost analysis of complications after craniotomy for brain tumor. Neurosurgery 2022;68:1-85.

Garcia AR, Turner S, Pizzo E, et al. Impact and experiences of delayed discharge: A mixed‐studies systematic review. Health Expect 2018;21(1): 41-56. doi: 10.1111/hex.12619.

Hyatt JC, Newman SL. Should a good risk manager worry about cost and price transparency in health care? AMA J Ethics 2020;22(11): E924-932. doi: 10.1001/amajethics.2020.924.

Joo JY, Huber DL. Barriers in case managers’ roles: a qualitative systematic review. West J Nurs Res 2018;40(10):1522-42. doi: 10.1177/0193945917728689.