Case management: the allocation of hours and influencing factors in the management of survivors of traumatic brain injury.

Case management is a service frequently provided to clients following a traumatic brain injury (TBI); however, the time required for this service is uncertain. To identify factors that influence case management for clients with TBI, a descriptive analysis of 64 client files were provided with case management services of a rehabilitation provider based in Sydney, Australia. These files were then further examined by using qualitative measures to determine the relationship among case management factors, time required and the severity of the injury. This information was statistically analyzed to identify what factors predicted the greatest use of case management time. The analysis identified inappropriate behavior, family dynamics, accommodation, and formal relationships as primary affectors on case management time. Other issues identified as less demanding of case management time were sustaining employment and provision of equipment. In terms of case management hours, the mean was 2.5 hr/ month. Where there was a combination of three factors, the time for case management increased to a mean of 3.97 hr, and up to 4.34 hr/month (range: 1.5-14.0 hr) of case management time where 4 factors were identified. A positive relationship between severity of posttraumatic amnesia (PTA) and care and needs score was also noted to impact on amount of case management time and duration of service.