Case management as a force for quality assurance and quality improvement in home care

To examine the extent to which case managers engage consciously in quality assurance activities for the services they purchase or arrange, semi-structured interviews were conducted with representatives of 75 case management agencies responsible for allocating home and community-based services with public funds, and 17 private, fee-for-service case management agencies. Relatively few agencies had developed formal criteria for defining quality, or systematic ways to assess it. Several types of quality oversight provided by case managers were identified: on-site review by case managers themselves, administrative review, and independent review by quality assurance staff. This article contains examples of best practices and discusses the policy implications of having case managers adopt a more explicit and rigorous role in assuring the quality of the services their clients receive.