Abstract
There have been plenty of articles published in recent decades on patient care in the form of case management (CM), but conclusions regarding health outcomes and costs have often been discordant. The objective of this study was to examine previous systematic reviews and meta-analyses with a view to assessing and pooling the overwhelming amount of data available on CM-based health outcomes and resource usage. We conducted a review of reviews of secondary studies (meta-analyses and systematic reviews) addressing the effectiveness of CM compared with usual care (or other organizational models) in adult (18+) with long-term conditions. PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched from 2000 to the end of December 2017. The outcomes of interest are related to process of care, health measures, and resource usage. Twenty-two articles were ultimately considered: 4 meta-analyses and 18 systematic reviews. There is strong evidence of CM increasing adherence to treatment guidelines and improving patient satisfaction, but none of the secondary studies considered demonstrated any effect on patient survival. Based on the available literature, there is contrasting evidence regarding all the other health outcomes, such as quality of life (QOL), clinical outcomes, and functional status. Good-quality secondary studies consistently found nothing to indicate that CM prompts any reduction in the use of hospital resources. The source of variability in the literature on the consistency of the evidence for most outcomes is unclear. It may stem from the heterogeneity of CM programs in terms of what their intervention entails, the populations targeted, and the tools used to measure the results. That said, there was consistently strong evidence of CM being associated with a greater adherence to treatment guidelines and higher patient satisfaction, but not with a longer survival or better use of hospital resources.
Highlights
The greatest challenge that health systems globally face in the 21st century concerns the gradual aging of the population, or rather the increasing burden of long-term conditions requiring ongoing management over a period of years or decades, and posing a great variety of health problems (Nolte and McKee, 2008: 1)
Case management (CM) is a method designed to provide intensive, personally tailored care to meet the needs of patients with multiple chronic conditions who are at greatest risk of needing hospitalization and responsible for the highest costs (Hutt et al, 2004)
We conducted a review of secondary studies on the efficacy/effectiveness of case management (CM) schemes for patients with longstanding conditions on multiple health outcomes and/or health service usage outcomes
Summary
The greatest challenge that health systems globally face in the 21st century concerns the gradual aging of the population, or rather the increasing burden of long-term conditions requiring ongoing management over a period of years or decades, and posing a great variety of health problems (Nolte and McKee, 2008: 1). Case management (CM) is a method designed to provide intensive, personally tailored care to meet the needs of patients with multiple chronic conditions who are at greatest risk of needing hospitalization and responsible for the highest costs (Hutt et al, 2004). This CM approach was defined by the Case Management Society of America as ‘a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes’ (Case Management Society of America, 2007).
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