Case management programs in primary care
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To review the impact of case management programs on health care resource use; their impact on patient satisfaction, quality of life, and functional status (patient-centered outcomes); and their cost-effectiveness, we reviewed the English language literature utilizing the following MEDLINE and Health-STAR headings: case management, patient care planning, patient-centered care, disease management, care management, and managed care programs. Bibliographies of relevant articles were also reviewed. Only randomized controlled trials were included. Data were extracted manually from relevant publications and are presented descriptively because formal, quantitative methods were not applicable. Nine studies met our inclusion criteria. Of the seven studies examining case management’s impact on health resource use, only two found a positive effect. Both successful programs targeted patients with specified disease conditions and care was supervised by a medical subspecialist. None of the programs targeting general disease conditions or supervised by generalists reported a positive effect. All six studies examining patient-centered outcomes reported a positive impact. These effects were unrelated to the patient’s conditions or the study personnel. Both studies examining clinical parameters found a positive impact. Only three studies examined costs; all reported nonsignificant cost savings. While case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to disease condition and specialty training of study personnel. Patient-centered outcomes were often improved upon but at unknown cost. Further multisite clinical trials are needed to define case management’s role in our future health care system.
- Stewart ME, Levit KR, Sensenig AL. National health expenditures, 1993. Health Care Finance Rev. 1994;16:247–94.
- Inglehart JK. Republicans and the new politics of health care. N Engl J Med. 1995;332:972–5. CrossRef
- Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993;12:162–73. CrossRef
- Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268:2388–94. CrossRef
- Hafner-Eaton C. Physician utilization disparities between the uninsured and insured: comparisons of the chronically ill, acutely ill, and well non-elderly populations. JAMA. 1993;269:787–92. CrossRef
- Lewin-VHI Inc. States as Payers: Managed Care for Medicaid Populations. Washington, DC: National Institute for Health Care Management; 1995.
- Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma. Ann Intern Med. 1990;112:864–71.
- Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190–5. CrossRef
- Weinberger M, Kirkman MS, Samsa GP, et al. A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life. J Gen Intern Med. 1995;10:59–66. CrossRef
- DeBusk RF, Houston-Miller N, Superko HR, et al. A case management system for coronary risk factor modification after acute myocardial infarction. Ann Int Med. 1994;120:721–9.
- Toseland RW, O’Donnell JC, Engelhardt JB, Hendler SA, Richie JT, Jue D. Outpatient geriatric evaluation and management: results of a randomized trial. Med Care. 1996;34:624–40. CrossRef
- Smith DM, Weinberger M, Katz BP, Moore PS. Postdischarge care and readmissions. Med Care. 1988;26:699–708. CrossRef
- Fitzgerald JF, Smith DM, Martin DK, Freedman JA, Katz BP. A case manager intervention to reduce admissions. Arch Intern Med. 1994;154:1721–9. CrossRef
- Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med. 1996;334:1441–7. CrossRef
- Cummings JE, Hughes SL, Weaver FM, et al. Cost-effectiveness of Veterans Administration Hospital-based home care: a randomized clinical trial. Arch Intern Med. 1990;150:1274–80. CrossRef
- Falcone D, Jaeger BJ. Case management of health services for older adults: apologies and promises. Raleigh, NC: Duke University Center for the Study of Aging and Human Development; 1988: 12:1–9.
- Ethridge P. A nursing HMO: Carondelet St. Mary’s Experience. Nurs Manage. 1991;22(7):22–7.
- Ethridge P, Lamb G. Professional nurse case management improves quality, access and costs. Nurs Manage. 1989;20(3):30–5.
- Gibson SJ, Martin SM, Johnson MB, Blue R, Miller DS. CNS-directed case management: cost and quality in harmony. J Nurs Admin. 1994;24(6):45–51. CrossRef
- Rogers M, Riordan J, Swindle D. Community-based nursing case management pays off. Nurs Manage. 1991;22(3):30–4.
- West JA, Miller NH, Parker KM, et al. A comprehensive management system for heart failure improves clinical outcomes and reduces medical resources utilization. Am J Cardiol. 1997;79:58–63. CrossRef
- Garabedian-Ruffalo SM, Gray DR, Sax MJ, Ruffalo RL. Retrospective evaluation of a pharmacist-managed warfarin anticoagulation clinic. Am J Hosp Pharm. 1985;42:304–8.
- Case management programs in primary care
Journal of General Internal Medicine
Volume 13, Issue 2 , pp 123-126
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- case management
- disease management
- care management
- patient-centered care
- managed care programs
- Industry Sectors