Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies.

Emily Chuanmei You,Colleen Doyle,Arthur Hsueh,David Dunt

doi:10.1186/1472-6963-12-395

Abstract

BackgroundCase management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes.MethodsWe searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented.ResultsTen RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above.ConclusionsAvailable evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes.

Highlights

Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness
We summarized the effects of case management in community aged care interventions based on whether the majority of studies reported significant, positive outcomes that favored the intervention group
Where the majority of available studies reported that the intervention group had statistically favorable outcomes compared with those of the control group, we reported in the results below that case management in community aged care interventions had significant effects on these outcome measures

Summary

Introduction

Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. Case management is described as a type of care delivery that has a long history of being applied in various settings, such as aged care, disability care, mental health and health care [2] It first emerged in nursing practice in the 1800s and was applied in social work practice in 1863 in the U.S [3,4]. Further associated developments in the 1970s, again in the U.S included deinstitutionalization, the independent living movement, increased number of community-dwelling older people with complex care needs, the fragmented care delivery system, and the need for cost control [6,7,8] Many developed countries, such as England, Canada and Australia, are attempting to integrate case management approaches into their aged care systems to provide comprehensive services for community-based frail elderly people

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Conclusion