Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis
Open Access
- 12 January 2013
- journal article
- review article
- Published by Oxford University Press (OUP) in Family Practice
- Vol. 30 (3), 266-275
- https://doi.org/10.1093/fampra/cms081
Abstract
Case management is a collaborative practice involving coordination of care by a range of health professionals, both within the community and at the interface of primary and secondary care. It has been promoted as a way of reducing unplanned admissions in older people. The objective was to systematically review evidence from randomized controlled trials regarding the effectiveness of case management in reducing the risk of unplanned hospital admissions in older people. Eighteen databases were searched from inception to June 2010. Relevant websites were searched with key words and reference lists of included studies checked. A risk-of-bias tool was used to assess included studies and data extraction performed using customized tables. The primary outcome of interest was enumeration of unplanned hospital admission or readmissions. Eleven trials of case management in the older population were included. Risk of bias was generally low. Six were trials of hospital-initiated case management. Three were suitable for meta-analysis, of which two showed a reduction in unplanned admissions. Overall, there was no statistically significant reduction in unplanned admissions [relative rate: 0.71 (95% confidence interval, CI: 0.49 to 1.03)]. Three trials reported reduced length of stay. Five trials were of community-initiated case management. None showed a reduction in unplanned admissions. Three were suitable for meta-analysis [mean difference in unplanned admissions: 0.05 (95% CI: −0.04 to 0.15)]. The identified trials included a range of case management interventions. Nine of the 11 trials showed no reduction of unplanned hospital admissions with case management compared with the same with usual care.Keywords
This publication has 21 references indexed in Scilit:
- “Impactibility Models”: Identifying the Subgroup of High-Risk Patients Most Amenable to Hospital-Avoidance ProgramsThe Milbank Quarterly, 2010
- A systematic review of integrated use of disease-management interventions in asthma and COPDRespiratory Medicine, 2009
- Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysisThe Lancet, 2008
- Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patientsBMJ, 2006
- A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department—The DEED II StudyJournal of the American Geriatrics Society, 2004
- Cost-Benefit Analysis of a Case Management Project for the Community-Dwelling Frail Elderly in Hong KongJournal of Applied Gerontology, 2004
- Effects of Comprehensive Follow-up Home Visits after Hospitalization on Functional Ability and Readmissions among Old Patients. A Randomized Controlled StudyScandinavian Journal of Occupational Therapy, 2002
- IndexJournal of Molecular Catalysis A: Chemical, 2000
- Efficacy of the Rehabilitation of Elderly Primary Health Care Patients After Short-Stay Hospital TreatmentMedical Care, 1992