Key result
Pilot case management team fails due to unintended consequences including ineffective targeting and role overlap.
Why the study?
Interventions to reduce avoidable readmissions are complex and can produce unintended consequences that cause failure, requiring identification during pilot implementation.
Implementing a case management team to reduce readmissions can lead to unintended consequences such as role overlap, patient confusion, and ineffective targeting, which can undermine the intervention's success.
Case management pilots for readmission reduction warrant caution over unintended consequences; leaves open optimal targeting and role designs for prospective trials.
Background: Countries are implementing interventions to reduce avoidable hospital readmissions. However, evaluating such interventions are potentially complex. These interventions can cause unintended consequences, and they are among the most common causes of the intervention's failure. The objective of this study was to identify the unintended consequences from implementing a pilot case management team to reduce avoidable hospital readmissions at a tertiary hospital in Singapore. Methods: We conducted five in-depth semi-structured interviews with stakeholders who were involved in the planning, development, and implementation of the intervention in addition to analysing 12 intervention documents. Deductive thematic analysis using Rogers' diffusion of innovation theory was conducted. Results: Data analysis generated seven subthemes: ineffective targeting of patient population, fund constraints, lack of patient ownership, limited post discharge follow up, comprehensive care approaches, role overlap and patient confusion. The absence of a readmission risk assessment tool resulted in care plan needs assessments being conducted for all admitted patients, rather than targeting those who would benefit most. This broad approach overwhelmed care coordination efforts. The initial plan to form a specialised intervention team responsible for care plan needs assessments could not be fully established due to funding constraints. As a result, the intervention team functioned more as a consulting service, providing recommendations to the primary team, which retained decision-making authority. Overlapping roles with existing case managers caused patient confusion, prompting the intervention team to step back and support care plan needs assessment remotely. Conclusion: Overall, results suggest that intervention team recognised a problem and participated in the intervention. This became the foundation for implementing change. However, the unintended consequences undermined the intervention from achieving its objectives and as a result the intervention was stopped. Decision-makers should pay attention to these unintended consequences to inform effective implementation and refine future interventions.
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Surendran et al. (2025) studied Avoidable hospital readmissions (n=5). Pilot case management team was evaluated on Unintended consequences from implementing a pilot case management team. Implementing a pilot case management team to reduce hospital readmissions generated 7 subthemes of unintended consequences, including ineffective targeting and role overlap, leading to its cessation.
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