Effectiveness of Nurse Case Management Compared with Usual Care in Cancer Patients at a Single Medical Center in Taiwan: A Quasi-Experimental Study

Purpose:

In order to improve treatment and care quality for cancer patients, nurse case management model
has applied generally in the clinical practice. However there were only few evidence-based studies on the relative
benefits in Taiwan. Further analysis and feedback application are needed. The aim of this study is to evaluate the
effectiveness of care quality in cancer patients with nurse case management.

Methods:

This study was conducted with a quasi-experimental design in a national medical center in Northern
Taiwan. Patients diagnosed as lung, liver, breast, colon, buccal or cervical cancers were eligible for inclusion. A total
number of 600 subjects randomly selected from the cancer case management system enrolled in the case
managed group, and 600 patients who received usual care were randomly selected from cancer registry and
enrolled in the control group. The study instrument was developed to measure care effectiveness, including the
rates of patient continuing treatment, non-adherence to treatment, prolonged hospitalization, unplanned
readmission, and planned admission for active treatment. The content validity of expert was assessed as 0.9.
Results: The nurse case management significantly decreased the unplanned readmission rate caused by infection
(1.5% vs. 4.7% in the control group, p = 0.002). The rate of patient continuing treatment in the institution
significantly increased in the case managed group (93.8% vs. 84.8% in the control group, p < 0.001). The planned
admission rates in 14 days and in 15–30 days for active treatment also significantly increased in the case managed
group (18.4.% vs. 3.9% in the control group and 34.5% vs. 10.4% in the control group, respectively, p < 0.001). The
results indicated that nurse case management provided better control in timeliness and continuity of patient
treatment.

Conclusions:

This study demonstrated that cancer case management could improve the effectiveness of cancer
care services and concretely illustrated a comprehensive model for oncology patients in Taiwan. In addition, the
model could be optimized for further application and improvement of cancer care. Future investigations are
needed to develop precise and rigorous evaluation to optimize the utilization of cancer case management.