Benefits of case management for chronic illness limited
Case management (CM) has some limited impact on patient-centered outcomes, quality of care, and resource use among patients with chronic medical illness, according to a new research review by the Agency for Healthcare Research and Quality (AHRQ). Chronic diseases are the leading cause of illness, disability, and death in the United States. CM is one strategy for improving patient care through designating a member of the health care team to manage multiple aspects of a patient's care, including planning and assessment, coordination of services, patient education, and clinical monitoring.
The review found that CM improves the quality of care, particularly for patients with serious illnesses that require complex treatments such as cancer and tuberculosis. For a variety of medical conditions, CM improves medical adherence and self-management skills. The impact of CM may be greatest when it is targeted towards patients with the highest previous levels of health care use, such as those with low levels of social support or patients at highest risk for poor outcomes.
Evidence shows no significant difference in overall costs of care due to CM. No conclusions could be drawn about whether specific case management characteristics or patient characteristics affected outcomes. Future clinical research should address gaps in the current evidence base, including looking at effective risk-assessment tools for choosing candidates for CM, understanding the length of time necessary to continue CM, and examining with greater precision the intensity of CM interventions and the variable characteristics of case managers.
These findings and others can be found in the research review Outpatient Case Management for Adults With Medical Illness and Complex Care Needs, which can be accessed on the AHRQ Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov.