Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

Abstract

PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.

Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis

“…To promote their engagement, all team members were invited to 2 working sessions, during which we focused the scope of the RS. Specifically, the review team identified the research question, clarified the purpose of the review, and articulated an initial program theory based on the findings of the parent systematic review 26 and other CM literature. The initial program theory consisted of the following 5 main resources: case finding, care planning, coordination/ integration of services, self-management support, and…”

“…As planned in our protocol, 25 we searched for evidence from all of the studies included in our parent systematic review detailing the methods and characteristics of the included studies. 26 The comprehensive search strategy used in our parent systematic review yielded 21 peer-reviewed articles published during the period 1996 to September 2017 and evaluating 19 interventions in primary care settings designed to improve care among adult frequent users of health care services who were affected by at least 1 chronic physical condition. In accordance with RS methodology supporting the inclusion of data from various sources, we used a cluster search to identify additional documents relevant to each CM intervention.…”

“…The extracted data were (1) bibliographic information, (2) study characteristics (location, setting, and design; definition of frequent users; population characteristics; 128 Documents from cluster searching of gray literature sample size; type, objective, frequency, and content of the intervention; length of the intervention sessions with patients; duration of follow-up; case-finding process; clinicians involved; intervention offered to the control group; data analysis; outcome characteristics and assessment instruments; and the intervention's effectiveness based on reported outcomes) (details of these findings are reported in the parent systematic review 26 ), and (3) data related to the CMO configurations.…”

“…The 19 included CM interventions were evaluated using quantitative methods (n = 16) and mixed methods (n = 3). 26 Thirteen were conducted in the United States and 6 in other countries (Sweden, Canada, Switzerland, Australia, New Zealand, and the United Kingdom). The studies included 17 to 14,140 participants, with an average age range of 20 to 66 years.…”

Tracing frequent users of regional care services using emergency medical services data: a networked approach

“…Subsequently, the appropriate answers to their needs, and consequently reducing the visits to ED and ambulance transports may be achieved. These solutions range from case management [4][5][6] to individual care plans, [7][8][9] and facilitated contacts with healthcare providers. 10 However, to be able to offer and consider such a form of advance care planning for apparently frail patients, they first need to be identified.…”