Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data

Gravelle, Hugh; Dusheiko, Mark; Sheaff, Rod; Sargent, Penny; Boaden, Ruth; Pickard, Susan; Parker, Stuart G; Roland, Martín

doi:10.1136/bmj.39020.413310.55

Cited by 212 publications

(232 citation statements)

References 9 publications

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“…These results could have an impact on the reduction of hospital admission rates from adverse drug reactions, on the overall costs of care as well as to improve the patients' quality of life. Nevertheless, in line with the findings of our study, the Evercare programme did not reduce hospital admissions, although they obtain an additional range of services into primary care (Gravelle et al 2007). …”

Section: Discussionsupporting

confidence: 88%

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

et al. 2008

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This research determines if the case management for health primary care means changes in: (a) frequency of use of social and health care resources, (b) number of patients visiting a doctor or social worker in the primary care centre, and visits that these professionals receive, (c) number of drugs consumed, (d) urgent hospital admittances which did not need significant intervention and (e) patients' and caregivers' satisfaction towards the social and health care resources received. The data were gathered with a questionnaire elaborated by the Administration and supervised by researchers. One hundred and fifty-two older dependent patients receiving home care in 2004, in a health department of the Valencia Region (Spain) collaborated. Results show: (a) Increase in the use of combined health and social resources in the intervention group; (b) number of patients visiting a practitioner or a social worker is lower in the intervention group, with a significant difference in both cases; (c) 33.3% of the patients in the intervention group versus 60.0% in the control group were admitted by the emergency room service for treatment that did not require surgery, but the difference is not significant; (d) 55.5% of these patients were very much satisfied with the care received and the benefits of the health care resources they had used versus 29.4% in the control group, showing a significant difference, 56.5% of the informal caregivers of patients in the intervention group were satisfied with the health care resources received by their family members, against 31.9% in control group.

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Section: Discussionsupporting

confidence: 88%

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

et al. 2008

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“…In accordance with the first law of planning: the supply of new services tends to uncover previously unmet needs and generate new demands. An association between case management and increased admissions has been seen before, 8 though focusing on so-called 'frequent flyers' may be the most cost-efficient course.…”

Section: Strengths Weaknesses Opportunities -And Threatsmentioning

confidence: 86%

Integrated care: final objective or fortuitous by-product?

Gillam

2012

Br J Gen Pract

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“…Evaluation of the potential for reductions in hospital admissions, 50 and the impact of one form of enhanced nurse practitioner working with older people in England, 51 was followed by a re-evaluation of the potential for case management to solve the problem of rising numbers of hospital admissions. Case management approaches have been shown to be appreciated by users and carers 52 and, in some configurations, to impact on functional health and well-being of recipients.…”

Section: Admission/readmission As a Policy Focusmentioning

confidence: 99%

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.

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Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data

Cited by 212 publications

References 9 publications

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

Integrated care: final objective or fortuitous by-product?

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

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