With the development of model systems in the 1970s, dedicated teams of rehabilitation professionals initiated the concept of case management. This occurred at about the same time that casualty insurers began using independent case managers. Since then, it is believed that persons with spinal cord injury (SCI) who have had the benefit of a case manager achieve and maintain better outcomes regarding health status, return to work, and modification and removal of architectural barriers. In general, these individuals have reported less depression and a more fulfilling lifestyle. The growth of managed care, with resultant abbreviated length of stay and diminished hands-on case management, may have a noticeably negative impact on adherence to clinical pathways and consequent successful outcomes. It is hypothesized that, despite technological advances, without comprehensive case management during all phases of SCI care, many individuals will not reach or maintain community reintegration and autonomy.

case management, clinical pathways, managed care, model systems
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