Effects of case management for frail older people or those with chronic illness: a systematic review.

BACKGROUND: Financial constraints and quality requirements demand that interventions selected are most effective. A previous systematic review of the effectiveness of the patient advocacy case management model was not found.
OBJECTIVE: The objective of this study was to evaluate the effects of patient advocacy case management on service use and healthcare costs for impaired older people or adults with a chronic somatic disease living in the community.
METHODS: A literature search was conducted in Medline, CINAHL, and Cochrane databases. Included were English-language randomized controlled trials evaluating service use and costs of the patient advocacy case management model for people with a chronic somatic disease or for impaired older people living in the community.
RESULTS: Eight relevant studies were identified and included after evaluation of methodological quality. All studies concerned frail or impaired older people, and one study also included people with a somatic chronic disease. In none of the studies was evidence found for clinically relevant increase of service use and costs, whereas in two studies, it was reported that patient advocacy case management led to decreased service use and to savings in costs. DISCUSSION: Patient advocacy case management does not increase service use and costs and was effective in decreasing service use and costs in two studies. These conclusions are an indication for quality improvement through the combination of its organizational benefits. Therefore, there should be more priority given to further implementation of patient advocacy case management for those with chronic illness and impaired older people. Nursing can play an important role in this development.