Young-Ju Kim1, Karen L Soeken. 1. School of Nursing, University of Maryland, Baltimore, 21201, USA. ykim007@son.umaryland.edu
Abstract
BACKGROUND: Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies. OBJECTIVES: The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate. METHOD: A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed. RESULTS: The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for stroke patients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely. DISCUSSION: The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.
BACKGROUND: Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies. OBJECTIVES: The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate. METHOD: A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed. RESULTS: The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for strokepatients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely. DISCUSSION: The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.
Authors: Hanneke W Drewes; Lotte M G Steuten; Lidwien C Lemmens; Caroline A Baan; Hendriek C Boshuizen; Arianne M J Elissen; Karin M M Lemmens; Jolanda A C Meeuwissen; Hubertus J M Vrijhoef Journal: Health Serv Res Date: 2012-03-14 Impact factor: 3.402
Authors: Debra K Moser; Victoria Dickson; Tiny Jaarsma; Christopher Lee; Anna Stromberg; Barbara Riegel Journal: Curr Cardiol Rep Date: 2012-06 Impact factor: 2.931
Authors: Kevin Hawkins; Paula M Parker; Cynthia E Hommer; Gandhi R Bhattarai; Jinghua Huang; Timothy S Wells; Ronald J Ozminkowski; Charlotte S Yeh Journal: Popul Health Manag Date: 2014-09-04 Impact factor: 2.459