Cost-effectiveness Of Case Management Research Articles

Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care: A Systematic Review and Meta-Analysis.

Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness. The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY. Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.

Cost-effectiveness of case management: a systematic review.

In this time of aging and increasingly multimorbid populations, effective and efficient case management approaches play a crucial role in supporting patients who are navigating complex health care systems. Until now, no rigorous systematic review has synthesized studies about the cost-effectiveness of case management. A systematic review was performed. The bibliographic databases PubMed and CINAHL Plus were systematically searched using key blocks and synonyms of the terms case management, effectiveness, and costs. The methodological quality of the studies was assessed using the Consensus Health Economic Criteria list. A total of 29 studies were included. In 3 studies, the intervention was less effective and more costly than the control group and can therefore be considered not cost-effective. Two studies found that the intervention was less effective and less costly. A more effective and less costly intervention, and therefore a strong recommendation for case management, was found in 6 studies. In 17 studies, the intervention was more effective while being more costly. Nearly half of the studies met most of the quality criteria, with 16 or more points out of 19. Existing studies often have adequate quality and, in many cases, show cost-effective or even cost-saving results. Case management appears to be a promising method to support patients facing complex care situations. However, variation among case management approaches is very high, and the topic needs further study to determine the most cost-effective way of providing such care coordination.

(Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728

BackgroundDementia is an incurable disease with devastating consequences for both patients and their relatives. The objective of this study is to describe the study protocol of a randomized controlled trial with assignment to either usual care or case-management by district nurses, among informal caregivers of older adults with dementia symptoms who live at home and the older adults who receive informal care.Methods/designIn this randomized controlled trial, effectiveness as well as cost-effectiveness of case-management is evaluated. It concerns case-management in early-detected patients with dementia symptoms and their primary informal caregivers. Participants are followed up to twelve months after baseline assessment. The main outcome measure of the effect evaluation is the caregiver's sense of competence to care for the older person with dementia symptoms. The economic evaluation is performed from a societal perspective.DiscussionThis is one of the first trials on case-management that includes an economic evaluation. In addition, it concerns a tailor-made intervention in early-detected patients with dementia symptoms and their caregivers. The results of this randomized controlled trial will provide valuable information for health professionals and policy makers on effectiveness and cost-effectiveness of early tailor-made case-management for patients and their informal caregivers. Moreover, positive effects will challenge current health care systems to move to more pro-active approaches for this group.

Does Case Management Work? The Evidence and the Abuse of Evidence-Based Medicine

This study reviews typologies of psychiatric case management and then discusses the efficacy, effectiveness and cost effectiveness of psychiatric case management, with particular focus on evidence from Australia and the UK. Subsequently, it aims to examine the way such evidence has been interpreted in the context of UK psychiatric research and services. Finally it examines the ways in which, by the selective reviewing or editorializing of evidence, case management has been brought into disrepute in the UK. This study reviews literature of the recent evidence for case management, and asks three questions of case management: has it been shown to be efficacious in controlled research, is it effective in applied settings, and is it cost effective? An examination is then made of the concurrent representations of the UK evidence in both the academic literature and the media. There is strong evidence for the efficacy effectiveness and cost-effectiveness of case management in psychiatry, the closer it conforms to active and assertive community treatment models. It appears, however, that studies and evidence-based reviews of case management have possibly been misused and misrepresented in a highly charged atmosphere of professional media debate. The potential for this abuse is not limited to psychiatry and remains a challenge for all evidence-based practice. On the evidence, assertive community treatment case management is one of the most effective interventions in psychiatry today. Despite improving the evidence base for practice (e.g. as has occurred for case-management in psychiatry), evidence-based medicine (EBM) is still susceptible to compromise and misrepresentation, due to unexamined or undeclared bias. Unless this potential for abuse is recognized and checked, EBM in psychiatry is in danger of being discredited at the hand of some of its own proponents. There is a need for more rigorous pursuit of evidence-based psychiatry, including more systematic declaration of bias in all research, whether quantitative or qualitative in design.

Cost-effectiveness of case management: experiences of a university managed health care organization.

Effective, multifaceted, and short-term case management services can result in significant, quantifiable cost savings for managed Medicaid, Medicare, and other health care programs. Such savings clearly offset the administrative costs of support for case managers, social services departments, and utilization management services. This report reviews various case management models, the costs for case management staff and resource support, and a number of quantified ways in which a social service and utilization management team model saved significant dollars in a number of different service areas. This cost-benefit analysis financially justifies administrative support for case management services in the budgets of managed Medicaid programs. Case management is a cost-effective and quality of care management tool.

The generalizability of brief ratings of psychosocial functioning

The multivariate generalizability of the Role Functioning Scale (RFS), serving as a replacement for the Social Adjustment Scale global ratings, was investigated. Severely mentally disturbed clients of a public mental health bureau, who were participating in one of two clinical trials that compared the cost-effectiveness of case management or substance abuse services, were interviewed and rated by psychiatric technicians, operating as four-person teams. The generalizability of single subscales was notably less than the generalizability of the combination of four subscales. Still larger differences in generalizability were noted between proposed future applications of the RFS that might employ one, as opposed to more than one, interviewer. Variations in the power to detect differences in service effectiveness were related to the levels of generalizability. Applications of this, or any, brief rating instrument should benefit from estimating the generalizability of the ratings for the proposed studies and employing estimates of generalizability to adjust sample size requirements.

The Impact of Case Management in Preventive Services

The success of case management in increasing the use of community-based services among a variety of chronically ill and medically fragile populations and in decreasing the frequency and length of stay of hospitalization is well documented. Less well established is its impact in preventive services and cost effectiveness, and the effect on health outcomes. The author discusses evidence of the effectiveness and cost effectiveness of case management in preventive services and other healthcare contexts. Finally, the author asks an important question, that is, what differentiates the context in which case management is effective from others? The author suggests that nurse case managers are the crucial determinant of successful case management.