Authors' objectives:

This report aims to provide an overview of the case management literature.

Authors' recommendations: A previous VA report on case management concluded that while case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to disease condition and specialty training of study personnel. Patient-centered outcomes are often improved upon but at unknown cost. The more recently published randomized controlled trials that were not available to the previous VA systematic review do not substantially alter the VA reviewers' conclusion. Further, several trials attributing positive impacts to case management were conducted in other countries (Italy, Australia, and UK), where cultural and health system differences from both VA and US standards may confound the results and limit generalizability. The recent randomized controlled trials, some with parallel cost or cost-effectiveness analyses, provide reasonable evidence that case management programs can benefit selected groups of patients. These groups, as noted in the previous VA review, can be classified by disease or by more heterogenous categories, such as geriatric patients or those in the posthospitalization period. However, potential benefits should be interpreted and extrapolated with caution, given the variability in case management models and program specifics reported in the literature. All retrieved cost or cost-effectiveness analyses related to case management for severe mental illness. Two of the three published analyses compared intensive (small caseload) to standard (larger case load) case management. The results of these analyses are mixed: case management programs can be more expensive for uncertain benefit, or can result in cost-effectiveness ratios that would, in turn, require comparison to analogous ratios for other programs to assist policy makers in resource allocation. Two case management trials have been published by VA investigators working with VA case management programs and within VA facilities: - A trial with homeless addicted veterans found that both case managed and control groups improved although the intervention group did have a statistical advantage. - A trial of intensive psychiatric community care found site-specific (general acute care medical centers versus long-stay psychiatric hospitals) cost effectiveness for this type of case management program. Differences in case management models and program specifics make interpretation of the literature a complex undertaking. These differences also limit direct comparability among programs used as interventions in published trials. In this context, further in-depth review of the case management literature would be considerably facilitated by definition of the types of programs, specific patient populations, care settings, and outcomes of greatest interest to VISN 1.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/CaseManagementPrograms2000tagm.pdf

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: Technology Assessment Unit, Office of Patient Care Services, US Department of Veterans Affairs (VATAP)