Case management for people with long-term conditions: impact upon emergency admissions and associated length of stay

Reilly, Siobhán; Abell, Jessica; Brand, Christian; Hughes, Jane; Berzins, Kathryn; Challis, David

doi:10.1017/s1463423611000028

Cited by 10 publications

(28 citation statements)

References 28 publications

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“…Of the 11 studies, eight were European, consisting of four studies (and five papers) from England, 48,49,52,54,55 two (related studies) in Germany, 27,46 one in Scotland 44 and one in Spain. 53 Three studies were undertaken in North America, one in Canada 45 and two in the USA (yielding three papers).…”

Section: Settingsmentioning

confidence: 99%

“…Study designs comprised three randomised controlled trials, 45,47,50 three cohort studies, 44,48,56 one cross-sectional study 55 and one further observational study. 46 Three wholly qualitative studies were included, 27,53,54 with qualitative methods also featuring in two others.…”

Section: Study Designsmentioning

confidence: 99%

“…Three studies reported findings relating to the use of multiple risk tools, as applied in different PCT areas, 48,52,56 although none provided a disaggregation of results by area or tool used. The Patients at Risk of Re-hospitalisation (PARR) tool was used in five studies.…”

Section: Risk Tools Identifiedmentioning

confidence: 99%

“…48,49,52,54,55 PARR uses data on prior hospitalisations to predict risk of rehospitalisation and, hence, calculates risk only for those patients with a previous admission. The combined predictive model was reported in three studies, 48,49,52 with single references to the Elder Risk Assessment (ERA), 50 Case Smart Suite Germany, 46 Length of stay, Acuity, Comorbidities, ED visits in previous 6 months (LACE), 45 Nairn Case Finder, 44 High Impact User Manager 52 and Adjusted Clinical Groups (ACGs). 53 An unnamed tool developed by the Senior Care Action Network Health Plan was used for the Levine et al study.…”

Section: Risk Tools Identifiedmentioning

confidence: 99%

“…A number of papers did include a reference 45,48,[50][51][52][53][54][55] to resources where details of the development and validation of the respective risk tools could be found. No technical performance details or references were included in three papers.…”

Section: Risk Tools Identifiedmentioning

confidence: 99%

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Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Snooks

Bailey-Jones

Burge-Jones

et al. 2018

Health Serv Deliv Res

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Background With a higher proportion of older people in the UK population, new approaches are needed to reduce emergency hospital admissions, thereby shifting care delivery out of hospital when possible and safe. Study aim To evaluate the introduction of predictive risk stratification in primary care. Objectives To (1) measure the effects on service usage, particularly emergency admissions to hospital; (2) assess the effects of the Predictive RIsk Stratification Model (PRISM) on quality of life and satisfaction; (3) assess the technical performance of PRISM; (4) estimate the costs of PRISM implementation and its effects; and (5) describe the processes of change associated with PRISM. Design Randomised stepped-wedge trial with economic and qualitative components. Setting Abertawe Bro Morgannwg University Health Board, south Wales. Participants Patients registered with 32 participating general practices. Intervention PRISM software, which stratifies patients into four (emergency admission) risk groups; practice-based training; and clinical support. Main outcome measures Primary outcome – emergency hospital admissions. Secondary outcomes – emergency department (ED) and outpatient attendances, general practitioner (GP) activity, time in hospital, quality of life, satisfaction and costs. Data sources Routine anonymised linked health service use data, self-completed questionnaires and staff focus groups and interviews. Results Across 230,099 participants, PRISM implementation led to increased emergency admissions to hospital [ΔL = 0.011, 95% confidence interval (CI) 0.010 to 0.013], ED attendances (ΔL = 0.030, 95% CI 0.028 to 0.032), GP event-days (ΔL = 0.011, 95% CI 0.007 to 0.014), outpatient visits (ΔL = 0.055, 95% CI 0.051 to 0.058) and time spent in hospital (ΔL = 0.029, 95% CI 0.026 to 0.031). Quality-of-life scores related to mental health were similar between phases (Δ = –0.720, 95% CI –1.469 to 0.030); physical health scores improved in the intervention phase (Δ = 1.465, 95% CI 0.774 to 2.157); and satisfaction levels were lower (Δ = –0.074, 95% CI – 0.133 to –0.015). PRISM implementation cost £0.12 per patient per year and costs of health-care use per patient were higher in the intervention phase (Δ = £76, 95% CI £46 to £106). There was no evidence of any significant difference in deaths between phases (9.58 per 1000 patients per year in the control phase and 9.25 per 1000 patients per year in the intervention phase). PRISM showed good general technical performance, comparable with existing risk prediction tools (c-statistic of 0.749). Qualitative data showed low use by GPs and practice staff, although they all reported using PRISM to generate lists of patients to target for prioritised care to meet Quality and Outcomes Framework (QOF) targets. Limitations In Wales during the study period, QOF targets were introduced into general practice to encourage targeting care to those at highest risk of emergency admission to hospital. Within this dynamic context, we therefore evaluated the combined effects of PRISM and this contemporaneous policy initiative. Conclusions Introduction of PRISM increased emergency episodes, hospitalisation and costs across, and within, risk levels without clear evidence of benefits to patients. Future research (1) Evaluation of targeting of different services to different levels of risk; (2) investigation of effects on vulnerable populations and health inequalities; (3) secondary analysis of the Predictive Risk Stratification: A Trial in Chronic Conditions Management data set by health condition type; and (4) acceptability of predictive risk stratification to patients and practitioners. Trial and study registration Current Controlled Trials ISRCTN55538212 and PROSPERO CRD42015016874. Funding The National Institute for Health Research Health Services Delivery and Research programme.

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Section: Settingsmentioning

confidence: 99%

Section: Study Designsmentioning

confidence: 99%

Section: Risk Tools Identifiedmentioning

confidence: 99%

Section: Risk Tools Identifiedmentioning

confidence: 99%

Section: Risk Tools Identifiedmentioning

confidence: 99%

See 3 more Smart Citations

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Snooks

Bailey-Jones

Burge-Jones

et al. 2018

Health Serv Deliv Res

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Nurse-led case management in the National Health Service: bridging clinical and social worlds

Manthorpe

Goodman

Drennan

et al. 2011

Prim Health Care Res Dev

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The opinions of older people receiving nurse case management reveal the value of high intensity support to individuals with major health and social needs. The NCMs' clinical expertise, the improved continuity of care they provided and the psychosocial support they offered, were all emphasised by older people or their carers. NCMs substituted for social workers in some cases, when the older person would not have been eligible for publicly funded social care or had declined it. In other cases, they supplemented social services by identifying unmet needs. In a third category of cases, they may have curtailed social services' involvement by preventing hospital admission and social services' involvement as a consequence. The implications of this from the viewpoint of other study participants are discussed.

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Organisational models in primary health care to manage chronic conditions: A scoping review

Longhini

Canzan

Mezzalira

et al. 2021

Health Social Care Comm

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Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.

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Case management for people with long-term conditions: impact upon emergency admissions and associated length of stay

Cited by 10 publications

References 28 publications

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

Nurse-led case management in the National Health Service: bridging clinical and social worlds

Organisational models in primary health care to manage chronic conditions: A scoping review

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