The Value of Research and Evidence-Based Practice in Care/Case Management

ABSTRACT: Patient complexity continues to rise due to multimorbidity, co-occurring behavioral health needs, and persistent health-related social needs. Care/case managers (CMs) are pivotal in navigating fragmented systems, advancing health literacy, and reducing preventable utilization. This article describes why research and evidence-based practice (EBP) are essential to modern CM practice; summarizes national quality trends with emphasis on the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQI-90); and outlines a multisite initiative to reduce potentially avoidable hospitalizations. Practice changes are highlighted including standardized care plans, proactive visit cadence, and 7-day postdischarge follow-up. These initiatives were supported by cross-functional governance, analytics, and Plan-Do-Study-Act (PDSA) improvement cycles. Lessons learned underscore the impacts of behavioral health, social needs, and technology-enabled workflows. The article concludes with recommendations to leverage embedded predictive models and integrated dashboards to demonstrate outcomes and sustain performance.