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Outpatient Case Management for Adults With Medical Illness and Complex Care Needs
Comparative Effectiveness Reviews, No. 99
Investigators: David H Hickam, MD, MPH, Jessica W Weiss, MD, MCR, Jeanne-Marie Guise, MD, MPH, David Buckley, MD, MPH, Makalapua Motu'apuaka, BS, Elaine Graham, MLS, Ngoc Wasson, MPH, and Somnath Saha, MD, MPH.
Author Information and AffiliationsStructured Abstract
Objectives:
In this evidence review we evaluated outpatient case management (CM) as an intervention strategy for chronic illness management. We summarized the existing evidence related to the effectiveness of CM in improving patient-centered outcomes, quality of care, and resource utilization in adults with chronic medical illness and complex care needs. We also assessed the effectiveness of CM according to patient and intervention characteristics.
Data Sources:
Articles were identified from searches of the MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects. The databases were searched through August 2011.
Review Methods:
Two reviewers evaluated abstracts and articles against prespecified inclusion criteria. Eligible studies were quality rated and data were extracted, entered into tables, and summarized. Due to the heterogeneity of outcomes, meta-analyses were not conducted. Systematic reviews were retrieved for reference, but data from pooled results of published reviews were not included in our analysis.
Results:
Of the 5,645 citations identified, we screened and reviewed 1,201 full-length articles and included 153 articles representing 109 studies. Many of the published trials of CM examined programs that targeted specific patient conditions, and the approaches to CM were diverse. Overall, the interventions tested in the studies were associated with only small changes in patient-centered outcomes, quality of care, and resource utilization. While CM can improve some types of health care utilization, there are minimal effects on overall costs of care. For selected populations, the characteristics of successful interventions included intense CM with greater contact time, longer duration, face-to-face visits, and integration with patients' usual care providers.
Conclusions:
Recognizing the heterogeneity of study populations, interventions, and outcomes, we sought to elucidate the conditions under which CM was effective. We found that CM had limited impact on patient-centered outcomes, quality of care, and resource utilization among patients with chronic medical illness.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Summary and Discussion
- Conclusions
- Future Research
- References
- Acronyms and Abbreviations
- Appendix A Definitions of Case Management
- Appendix B Exact Search Strings
- Appendix C Inclusion and Exclusion Criteria
- Appendix D Included and Excluded Studies
- Appendix E Defining Complex Care Needs
- Appendix F Quality Assessment Methods
- Appendix G Quality Assessment of Randomized Trials and Observational Studies
- Appendix H Strength of Evidence
- Appendix I Evidence Tables
- Appendix J Appendix References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10057-I. Prepared by: Oregon Evidence-based Practice Center, Portland, OR
Suggested citation:
Hickam DH, Weiss JW, Guise J-M, Buckley D, Motu'apuaka M, Graham E, Wasson N, Saha S. Outpatient Case Management for Adults With Medical Illness and Complex Care Needs. Comparative Effectiveness Review No. 99. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No.13-EHC031-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others— make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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