Case management: effects on professional practice and health care outcomes

  • Protocol
  • Intervention

Authors

  • Merrick Zwarenstein,

    Corresponding author
    1. Sunnybrook Health Sciences Centre, Combined Health Services Sciences, Toronto, ON, Canada
    • Merrick Zwarenstein, Combined Health Services Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room G1 06, Toronto, ON, M4N 3M5, Canada. merrick.zwarenstein@ices.on.ca.

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  • Scott Reeves,

    1. Wilson Centre for Research in Education, Department of Psychiatry, Li Ka Shing Knowledge Institute & Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada
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  • Sharon E Straus,

    1. Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Knowledge Translation Program, Toronto, Ontario, Canada
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  • Patricia Pinfold,

    1. Toronto, Ontario, Canada
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  • Joanne Goldman

    1. Li Ka Shing Knowledge Institute of St. Michael's Hospital, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

We will review rigorous intervention studies which address the following question:

Does case management affect the acceptability of patients, and the quality, efficiency and effectiveness of care, ie are patients assigned to case management healthier, more satisfied, better or more quickly cared for, or cared for at lower cost than those not assigned to case management?

The specific objectives of this review are:

1. To search the literature for studies which evaluate case management interventions. Studies to be included in the review will be aimed solely or separately at evaluating case management interventions. Studies excluded on methodological grounds may be used to describe the level of development of research in this field. Studies will be included only if they use a sufficiently rigorous design to evaluate the effects of the intervention on outcomes of care. Studies which address psychiatric care will be excluded, as a review has already been completed on this topic (Marshall 2000).

2. To describe the overall effects of case management on patient care. Outcomes will include length of stay, resource use, patient satisfaction, survival, unplanned readmission, complications, iatrogenic disease and other quality of care measures and measures of professional practice.

3. To summarise narratively, qualitatively by simple study count and, if possible through meta-analysis, the effect of interventions on outcome.

4. To investigate the effects on patient care of different models of case management: some named models are brokerage, integrated case management, patient empowerment, integrated care pathways, managed clinical networks, liaison services and locality care. Differences in case managers (graduate nurses, clinical nurses, other professions, non professionals) working alone or in teams, motivation behind the development of programmes (quality of care, cost containment), times of initiation (at admission, during stay, at discharge, in community), settings (academic hospital, acute hospital, long stay hospital, primary care, community services) and approaches to evaluating the need for interdisciplinary intervention (problem based versus scheduled follow up) are variants of models which may result in different outcomes, whose impact will be explored.