Case Management Effectiveness on Health Care Utilization Outcomes: A Systematic Review of Reviews

Abstract

Case management is a cost-effective strategy for coordinating chronic illness care. However, research showing how case management affects health care is mixed. This study systematically synthesizes and critically evaluates evidence in systematic reviews of health care utilization outcomes from case management interventions for the care of chronic illnesses. Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions. There was evidence that these interventions positively reduced health care utilization; however, results were mixed. These results and the implications of this review of reviews may be valuable for clinical practitioners, health care researchers, and policymakers.

Understanding Nurse-led Case Management in Patients with Chronic Illnesses: A Realist Review

“…Despite the step forward the Huber–Hall dosage model represented, there is still little knowledge about how and why CM works. CM interventions also still lack theoretical foundation (Park & Huber, 2009; Joo & Huber, 2019). A theoretical framework is necessary for CM practice and research to advance (Kneipp et al, 2011; Park & Huber, 2009; Joo & Huber, 2019).…”

“…CM interventions also still lack theoretical foundation (Park & Huber, 2009; Joo & Huber, 2019). A theoretical framework is necessary for CM practice and research to advance (Kneipp et al, 2011; Park & Huber, 2009; Joo & Huber, 2019). Therefore, this realist review aims to better understand how, why, and in what circumstances nurse-led CM interventions are successfully implemented to manage individuals with chronic illnesses.…”

Case Management: An Evolving Role

“…While the majority of case managers are nurses, case management is inherently interdisciplinary in nature. It is essential that programs consider how to educate across disciplines in a way that affords students the opportunity to interact with other professions to define interdisciplinary case management (Joo & Huber, 2018). Joo and Huber's (2018) qualitative systematic review offers insight into the frequent challenges case managers encounter with potential solutions to support better outcomes for our most vulnerable populations.…”

“…It is essential that programs consider how to educate across disciplines in a way that affords students the opportunity to interact with other professions to define interdisciplinary case management (Joo & Huber, 2018). Joo and Huber's (2018) qualitative systematic review offers insight into the frequent challenges case managers encounter with potential solutions to support better outcomes for our most vulnerable populations. Case managers have some of the greatest insight into how limitations in health care and patients' health behaviors intersect to create challenges in disease management.…”

“…In this issue, Joo and Huber (2018) highlight the continued challenges faced by care managers: unclear scope of practice, diverse and complex care management activities, insufficient training, and challenging relationships with other health care providers and clients which is in part due to the case manager’s advocacy role. The authors recommend potential solutions to these challenges include developing clear guidelines and professional standards, incorporating evidence-based practice and situational learning across health care settings and populations, continuously evaluating case management competencies, and making systems improvement where needed to improve practice and achieve goals.…”