Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

Abstract

ObjectivesThe aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).SettingCM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.ParticipantsAdults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.InterventionCM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.Primary and secondary outcomesPrimary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.Results22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.ConclusionsHospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.

Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis

“…A recent systematic review has concluded that hospital‐initiated case management continuing in the community for patients with heart failure can reduce subsequent unplanned admissions and hospital length of stay (Huntley et al. ).…”

“…These approaches are thought to be key to reducing admissions (Boren, Wakefield, Gunlock, & Wakefield, ; Ditewig, Blok, Havers, & van Veenendaal, ; Jovicic, Holroyd‐Leduc, & Straus, ). However, few case managements for heart failure trials focused on the mechanisms for the better monitoring of signs and symptoms, although a minority describe components such as patient‐directed access, referral to other services, assessment of home environment and emotional support (Huntley, Johnson, King, Morris, & Purdy, ).…”

Case management effectiveness for managing chronic illnesses in Korea: a systematic review

“…For instance, systematic reviews have shown that case management resulted in statistically significant reductions in hospital utilization, including days in hospital, and in increased quality of and satisfaction with care (Huntley et al. ; Joo & Liu ; You et al. ).…”

“…And Huntley et al. () found that hospital‐initiated case management was strongly associated with reducing hospital readmission for heart failure. You et al.…”

“…In developed countries such as the United States, Canada and the United Kingdom, case management has been reported as an effective care-coordination strategy for chronic illnesses (Joo 2014;Park & Huber 2009;Park & Kim 2008;You et al 2013). For instance, systematic reviews have shown that case management resulted in statistically significant reductions in hospital utilization, including days in hospital, and in increased quality of and satisfaction with care (Huntley et al 2016;Joo & Liu 2017;You et al 2013). In a systematic review of randomized-controlled trials in the United States and Europe, Joo & Liu (2017) found strong evidence that case management reduced hospital use, especially emergency department visits, by persons with chronic illnesses.…”