Hospital-based Case Management Research Articles

Effect of hospital-based case management on psychosocial wellbeing and treatment outcomes in colorectal cancer patients: A quasi-experimental study.

Case management has been regarded as the front line of necessary change for fragmented healthcare system. This study proposed a case management intervention that is suitable for Chinese colorectal cancer patients and explored its effectiveness over a 12-month follow-up. A quasi-experimental study was conducted in an oncology hospital in China. A total of 188 patients were recruited from May 2015 to February 2017; 85 patients in the control group and 80 patients in the intervention group were included in data analysis. The intervention group was managed for 1 year by a case manager who organized the multidisciplinary team, provided regular assessment, a consulting service and referrals. Quality of life, anxiety and depression, symptom distress, treatment adherence and unplanned readmission rates were measured. Repeated measurement ANOVA showed significant intervention and time effects in global quality of life, anxiety and depression, symptom distress and oral chemotherapy adherence. The intervention group showed statistically significantly better overall treatment adherence and lower unplanned readmission rate. Nurse-led case management was effective in improving psychosocial outcomes, treatment adherence and unplanned readmission rate of colorectal cancer patients. A case management model is feasible and effective in colorectal cancer patients and in hospital-dominated healthcare systems where primary care is underutilized.

A Replicable, Solution-Focused Approach to Cross-Sector Data Sharing for Evaluation of Community Violence Prevention Programming.

Community violence is a public health problem that erodes social infrastructure. Structural racism contributes to the disparate concentration of violence in communities of color. In Mecklenburg County, North Carolina, increasing trends in community violence show racial and geographic disparities that emphasize the need for cross-sector, data-driven approaches to program and policy change. Cross-sector collaborations are challenged by data sharing barriers that hinder implementation. In response to community advocacy, Mecklenburg County Public Health (MCPH) launched a Community Violence Prevention Plan with evidence-based programming. The Cure Violence (CV) model, a public health approach to disrupting violence through equitable resource provision, network building, and changing norms, was implemented at the community level. The Health Alliance for Violence Intervention (HAVI) model, a hospital-based screening and case management intervention for victims of violence, was implemented at Carolinas Medical Center in Charlotte, the region's only level I trauma center. A data collaborative was created to optimize evaluation of CV and HAVI programs including MCPH, the city of Charlotte, Atrium Health, Charlotte-Mecklenburg Schools, Johnson C. Smith University, and the University of North Carolina Charlotte. A comprehensive approach to facilitate data sharing was designed with a focus on engaging stakeholders and generating solutions to commonly reported barriers. Structured interviews were used to inform a solution-focused strategy. Stakeholders reported perceptions of their organization's barriers and facilitators to cross-sector data sharing. Common technology, legal, and governance barriers were addressed through partnership with a local integrated data system. Solutions for trust and motivational challenges were built into ongoing collaborative processes. Data silos inhibit the understanding of complex public health issues such as community violence, along with the design and evaluation of collective impact efforts. This approach can be replicated and scaled to support cross-sector collaborations seeking to influence social and health inequities stemming from structural racism.

Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey.

Objective As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care. Methods We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management. Results The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions. Conclusion Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

Nutritional screening in a case management program for community-living older individuals at high risk of hospital admission.

The prevalence of malnutrition in older persons depends on the healthcare setting. In recent years, hospital-based case management programs (CM Programs) targeting individuals in the community with chronic multimorbidity and high use of hospital resources (admissions or emergency visits) have been developed in many countries to reduce the need for complex health care. The objective of this study was to assess the prevalence of risk of malnutrition, using the Short Form of the Mini-Nutritional assessment, of community dwelling patients included in a chronic CM Program. Factors associated with malnutrition risk were also explored. Patients included in a hospital-based integrated CM Program for older persons at high risk for hospital readmission after an index admission were studied. MNA-SF was used at program inclusion to assess the risk of malnutrition. An array of factors potentially associated with malnutrition were explored (including feeding route, use of dental prosthesis, dysphagia, consistency of foods, specific therapeutic diets, use of oral nutritional supplements, polypharmacy, falls, and other diseases and geriatric syndromes). 791 participants were included, mean age 79.8years, 50.1% females. Risk of malnutrition was present in 44.9%. Participants at risk of malnutrition were more frequently female, had a lower BMI, were less likely to be fed orally and used more nutritional supplements. They also had a higher prevalence of dysphagia, needing changes in food consistency or using specific therapeutic diets, and had dementia or cancer more frequently. They also showed a higher need for palliative care. Risk of malnutrition in patients included in a CM Program is higher than in non-selected community dwelling older individuals. This information may help inform screening policies in similar populations at risk of hospital readmission.

Effectiveness of a Comprehensive Case Management Service for Children With Medical Complexity.

To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs. Eligible CMC at Seattle Children's Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested. Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group (n = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5-9.8] vs 1.3 [95% CI: 1.9-4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701-$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year. Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.

Supporting the Support System: How Assessment and Communication Can Help Patients and Their Support Systems.

The benefits of having a support system, such as social relationships with close friends and family, have been well documented for patients with serious health issues. As scientific evidence has shown, individuals who have the lowest level of involvement in social relationships face a greater mortality risk. Support systems, however, are not infallible. Relationship stress can have a negative impact on people-patient and caregiver alike-behaviorally, psychosocially, and physiologically. The purpose of this article is to encourage case managers who take a patient-centered approach to also consider the existence and extent of the support system, as well as any stresses or tensions that are observable within the support system. Although the case manager is ethically obliged to advocate for the individual receiving case management services, that advocacy can be extended to the support system for the good of all. This discussion applies to numerous case management practices and work settings including (but not limited to) hospital-based case management, home health, geriatrics, catastrophic case management, mental health, palliative care, and end of life/hospice. As part of the assessment phase of the case management process, case managers determine the extent of the patient's support system or social support network such as family and close friends. Although their advocacy is primarily for the patient receiving case management services, case managers also become aware of the needs of the support system members as they face their loved one's serious illness, severe injury, geriatric care demands, or end of life. Case managers can use their communication skills, especially motivational interviewing, with patients and their support systems to identify stresses and issues that can impact the pursuit of health goals. In addition, case managers ensure that individuals and their support systems are kept informed such as about the health condition, stage of disease, plan of care, treatment options, and care transition plan. Professional case managers expand their role as advocates, serving primarily the patients ("clients") who receive case management services and also members of the support system. By becoming more aware and sensitive to the needs of the support system, case managers help reduce stress on the support system, which can contribute to positive outcomes for patients ("clients").

Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease

Objectives:Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children’s university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT.Methods:Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT.Results:Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases).Significance of Results:This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT.

Case management hospitalario (manejo de casos): una forma alternativade manejar pacientes de alto riesgode estadías hospitalarias prolongadas,de reingreso, o con múltiplesrequerimientos al momento del alta

Due to demographic changes, rising health expenditures, and the reimbursement mechanisms of insurers in the past 30 years, physicians and nurses have had to change the way services are delivered. Concepts such as cost effectiveness and patient safety have also led to the emergence of case management. Case management, usually led by nurses, is responsible for early recognition of patients at high risk for prolonged hospitalization, readmission, a high level of consumption of healthcare resources, and mobilizing strategies to discharge patients as soon as possible in a safe manner with appropriate medical follow-up. Additionally, the case management teams are responsible for patient education in a systematic way, for proper codification of diagnoses, and for ensuring proper documentation at the moment of discharge. Case management has proven to reduce the length of hospital stays and readmissions. It also facilitates the care of patients who are overwhelmed by the increasingly complex hospital procedures that they must endure. This is an exhaustive review of the literature about hospital-based case management, its origins, characteristics, types, and how it has produced a positive impact on patient safety and metrics within hospitals.

A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care: a General Practitioner Perspective

Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care. Aim. To analyse the effects of hospital-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention. Patients were recruited at a Danish surgical department. An ad hoc piloted questionnaire was sent to all patients' GPs 30 weeks after patients' recruitment and the responses from the two groups of GPs were compared. Registry data on patients' contacts with general practice during daytime and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs of CM patients reported contacting the hospital. CM did not affect the number of patient contacts with the GPs during the daytime, but CM patients showed a tendency towards more contacts to the out-of-hours GP services than non-CM patients. CM was appreciated by the GPs and reduced their need for subsequent hospital contact. CM increased the number of patient contacts to the out-of-hours GP services.

A randomised controlled trial of hospital-based case management to improve colorectal cancer patients’ health-related quality of life and evaluations of care

ObjectiveTo analyse the effectiveness of hospital-based case management (CM) in terms of patient-reported outcomes.DesignRandomised controlled trial allocating participants 1 : 1 to either a CM intervention or a control group....

Effectiveness of case management for adult patients with chronic liver disease: a systematic review.

Review Question/Objective The objective of this systematic review is to synthesise the best available evidence on the effectiveness of case management for adult patients with chronic liver disease. Inclusion Criteria Types of participants Chronic liver disease patients This review will consider adult patients aged over 16 years, with a clinical diagnosis of CLD at any stage, including hospital-based case management participants. CLD will be defined as those who had HCV-antibody or HBsAg positive for more than six months, elevated serum alanine aminotransferase (ALT) level, clinically compensated or decompensate liver cirrhosis, hepatocellular carcinoma (HCC) either confirmed by liver histology or typical image studies. The exclusion criteria will include the following: patients with a coexisting chronic debilitating illness such as end-stage renal disease, stroke, inflammatory bowel disease, epilepsy, mental illness and malignancies other than HCC. Types of Interventions This review will consider any studies with a focus on case management interventions predominantly aimed at improving care coordination and nursing care quality of CLD patients including health education and program, social support, and integration of primary care and specialist management and disease management. This review will focus on coordination of multidisciplinary care and the integration of this with patients’ needs. We anticipate that such studies will generally have used a validated QOL tool to evaluate the effect of the case management intervention on patients’ quality of life. Types of outcomes The outcomes will include, but are not limited to: 1. Quality of care, as measured by self-designed evaluation questionnaires, e.g. awareness of disease, and satisfaction of health education, and patients’ overall satisfaction 2. Quality of life, as measured with any validated QOL instrument, such as generic (SF-36) and disease-specific scales (Chronic Liver Disease Questionnaire) of HRQOL 3. Hospitalisation costs, e.g. patients’ hospital stay

Understanding the Medicare “Extended Care Benefit” a.k.a. the 3-Midnight Rule

The purpose of this article is to discuss the overall features of the "Extended Care Benefit," also known as the 3-midnight rule for post-acute skilled nursing facilities (SNF) coverage. The goal is to support case managers in the effort to gain a better understanding of how the benefit applies to the Medicare beneficiaries with whom they are working. (1) Give a brief history of the purpose of the "extended care benefit," (2) describe the circumstances under which a patient may be eligible for coverage of skilled nursing or rehabilitation services following a hospitalization, and (3) apply new knowledge to practice by incorporating case management tips into practice. The primary setting for case managers who need to know this information is in acute care and in postacute care facilities that admit patients for extended care services. The eligibility of Medicare beneficiaries for this benefit may be broader than is commonly known by case managers. 1. Case managers should not "assume" that the patient does not meet criteria for this benefit. For example: Even if the patient is not ready for rehabilitation services at the time of discharge, a case manager can advocate for deferred admission when the patient is ready. 2. Case managers should include in the patient's admission assessment, the history of previous hospitalizations, particularly in the past 30 days. The patient may have met the 3-midnight requirement prior to admission. 3. Hospital-based case managers must work closely with intake staff, case managers, or liaison staff from the SNF level of care to do a comprehensive assessment of the patient's continuing care needs. 4. Delivering the message to Medicare beneficiaries and their families that the patient does not meet criteria for "extended care services" is a very difficult task and should be done in collaboration with other team members, particularly social workers. 5. With 43% of all admissions of patients being in the "short-stay" category, early intervention is critical to determine the possibility of the patient's postacute needs. It is the short-stay patient who does not meet medical eligibility for 3 days who needs more attention early in the stay. 6. Keeping a patient in the hospital, who does not meet medical necessity standards, even for 1 day with the purpose of meeting the 3-day rule may be considered to be "fraudulent," and is a serious matter. Acute care setting is intended to provide acute care services and not to be used to help "needy" individuals meet criteria for extended care benefits.

The Effectiveness of Hospital-Based Diabetes Case Management: An Example From a Northern Taiwan Regional Hospital

The aim of this study was to design, implement and evaluate disease outcomes at a regional hospital- based case management program of care for patients with type 2 diabetes. A medical team and practice guidelines were established in line with the health insurance strategy of Taiwan's Bureau of National Health Insurance (BNHI) and American Diabetes Association (ADA) Standards of Care for Diabetes (2003 edition). Also, a set of self-care booklets was designed suitable for use by the subject group. The study was prospective and followed the patients from enrollment to one year. Patient outcomes were determined based on laboratory examinations and recorded self-care behavior. Data were collected at enrollment and over 4 follow-up times within a one year period. Generalized Estimating Equation (GEE) multiple linear regression and logistic regression were used for repeated measurements and adjustments of the effects of specific prognostic factors. Sixty subjects diagnosed with type 2 diabetes (mean duration 3.25 years) were recruited. All participants were married with a mean age of 52.5 years. A majority (58.3%) was male and 65% were ethnic Hakka. Self-care knowledge and behavior accomplishment rates were: taking medications by oneself, 91.3% (knowing medicines, 25.4%); hypoglycemia management, 23.3%; monitoring blood sugar, 46.7%; exercise, 35.8%; diet management, 51.7% and foot care, 92.8%. Significantly improved ADA diabetes care standard items included HbA1C (p< .0001), fasting glucose (p< .01) and triglycerides (p< .05). The study incorporated evidence-based guidelines, public health insurance strategies and self-care booklets into a protocol to provide comprehensive care. The implemented diabetes program achieved diabetes care goals and improved patient self-care.

Transition of care for hospitalized elderly patients—Development of a discharge checklist for hospitalists

Discharge from the hospital is a critical transition point in a patient's care. Incomplete handoffs at discharge can lead to adverse events for patients and result in avoidable rehospitalization. Care transitions are especially important for elderly patients and other high-risk patients who have multiple comorbidities. Standardizing the elements of the discharge process may help to address the gaps in quality and safety that occur when patients transition from the hospital to an outpatient setting. The Society of Hospital Medicine's Hospital Quality and Patient Safety committee assembled a panel of care transition researchers, process improvement experts, and hospitalists to review the literature and develop a checklist of processes and elements required for ideal discharge of adult patients. The discharge checklist was presented at the Society of Hospital Medicine's Annual Meeting in April 2005, where it was reviewed and revised by more than 120 practicing hospitalists and hospital-based nurses, case managers, and pharmacists. The final checklist was endorsed by the Society of Hospital Medicine. The finalized checklist is a comprehensive list of the processes and elements considered necessary for optimal patient handoff at hospital discharge. This checklist focused on medication safety, patient education, and follow-up plans. The development of content and process standards for discharge is the first step in improving the handoff of care from the inpatient to the posthospital setting. Refining this checklist for patients with specific diagnoses, in specific age categories, and with specific discharge destinations may further improve information transfer and ultimately affect patient outcomes.

Review: hospital based case management does not reduce length of hospital stay or readmissions in adults

Review: hospital based case management does not reduce length of hospital stay or readmissions in adults

Effect of a Hospital-based Case Management Approach on Treatment Outcome of Patients with Tuberculosis

Background/PurposeTuberculosis (TB) continues to pose a heavy public health burden in Taiwan. This prospective study analyzed the factors influencing treatment outcome in patients with TB treated with and without a hospital-based case management (HBCM) approach in a referral center in Taipei.MethodsA register-based cohort study design was used to enroll all new cases of pulmonary or extra-pulmonary TB from February 2003 to January 2004. The case manager served as the coordinator among patients, physicians and public health nurses, to facilitate compliance with anti-TB treatment. Treatment outcomes were assessed according to the consensus recommendations of the World Health Organization and the International Union Against Tuberculosis and Lung Disease.ResultsSuspected or confirmed pulmonary or extrapulmonary TB was diagnosed in 524 patients in our hospital from February 2003 to January 2004. Fifty-two of these patients were excluded due to duplicate reporting, previous treatment or death before enrollment. Out of 472 patients enrolled, 103 whose original diagnosis was revised were further excluded, leaving 369 cases eligible for analysis. Patients with case management had a significantly higher rate of successful treatment (cured plus completed treatment) compared to patients without case management, (240/277, 86.6% vs. 67/92, 72.8%; p = 0.002). The overall successful treatment rate including both case and non-case management was 83.2% (307/369), which was higher than the nationwide surveillance data of 78.3% in 2002 and 69.4% in 2003.ConclusionTreatment of TB patients by a HBCM approach provides improved treatment outcomes compared to those without case management.

A Meta-Analysis of the Effect of Hospital-Based Case Management on Hospital Length-of-Stay and Readmission

Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies. The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate. A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed. The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for stroke patients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely. The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.

Discharge planning: a collaboration between provider and payer case managers using Medicare's Conditions of Participation.

Discharge planning is a legally mandated function for hospitals and is one of the "basic" hospital roles as outlined in Medicare's Conditions of Participation. This article will define discharge planning; describe the steps in the discharge planning process; list rules and regulations that influence discharge planning in hospitals; and compare hospital-based actions with payer-based actions when planning discharges. Case managers who work for payers interact with hospital-based case managers to facilitate the discharge planning process for patients. Those who form this patient-provider-payer triangle will benefit by reviewing the dynamics of the discharge planning process.

Hospital Case Managers: Diamonds in the Rough

Marianne Ramey, RN, is a partner at PHOENIX Medical Management, Inc., a Pompano Beach, Florida-based consulting firm exclusively devoted to the design, management, and education of hospital-based case management programs. Ms. Ramey can be reached via e-mail: [email protected] Stefani Daniels, RN, BSN, MSNA, is founder and managing partner at PHOENIX Medical Management, Inc. She is a former hospital operations officer, an adjunct instructor at Nova Southeastern University in Ft. Lauderdale, and a frequent guest at regional and national conferences. She can be reached via e-mail: [email protected] Address correspondence and reprint requests to: Stefani Daniels, RN, BSN, MSNA, PHOENIX Medical Management, Inc., 1401 S. Ocean Boulevard, Suite 402, Pompano Beach, FL 33062 (e-mail: [email protected]).

A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery disease patients: the Heartcare I Trial

BACKGROUND: Case-management programs for secondary prevention of coronary artery disease that utilize extensive resources can reduce cardiovascular risk factors, but less intensive approaches have failed to show benefits. This randomized trial evaluated whether a medium intensity case-management program improves risk factor control in patients with coronary artery disease. METHODS: We assigned 201 consecutive patients hospitalized for acute coronary events in the intensive care unit of University Hospital, Basel, Switzerland, to either a risk factor case-management program (n = 99) or care as usual (n = 102) using the patients’ primary care physicians as the unit of randomization (cluster randomization). The case-management program consisted of an hour of counseling by a clinician during hospitalization and two short reminders by phone and mail 3 and 6 months later. Treatment decisions were left to patients and their primary care physicians. RESULTS: After 9 and 18 months of follow-up, there were no significant differences in lipid values, blood pressure control, fasting blood glucose, body-mass index, or number of smokers between the two groups. However, significantly more patients in the intervention group than in the care as usual group achieved target cholesterol values after 18 months (48% versus 27%, P = 0.002 and remained significant after Bonferroni-Holms correction) but not after 9 months of follow-up (31% versus 27%, P >0.2). CONCLUSION: This hospital-based case-management and outreach program, limited to counseling by a clinician, did not substantially improve cardiovascular risk factor control among patients hospitalized for coronary events.