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A systematic review of care management interventions targeting multimorbidity and high care utilization

BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management intervent...

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Autores principales: Baker, Jennifer M., Grant, Richard W., Gopalan, Anjali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791200/
https://www.ncbi.nlm.nih.gov/pubmed/29382327
http://dx.doi.org/10.1186/s12913-018-2881-8
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author Baker, Jennifer M.
Grant, Richard W.
Gopalan, Anjali
author_facet Baker, Jennifer M.
Grant, Richard W.
Gopalan, Anjali
author_sort Baker, Jennifer M.
collection PubMed
description BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the following three patient groups: adults with two or more chronic medical conditions, adults with at least one chronic medical condition and concurrent depression, and adults identified based solely on high past or predicted healthcare utilization. METHODS: Eligible studies were identified from PubMed, published between 06/01/2005 and 05/31/2015, and reported findings from a randomized intervention that tested a comprehensive, care management intervention. Identified interventions were grouped based on the three “complex” categories of interest (described above). Two investigators extracted data using a structured abstraction form and assessed RCT quality. RESULTS: We screened 989 article titles for eligibility from which 847 were excluded. After reviewing the remaining 142 abstracts, 83 articles were excluded. We reviewed the full-text of 59 full-text articles and identified 15 unique RCTs for the final analysis. Of these 15 studies, two focused on patients with two or more chronic medical conditions, seven on patients with at least one chronic medical condition and depression, and six on patients with high past or predicted healthcare utilization. Measured outcomes included utilization, chronic disease measures, and patient-reported outcomes. The seven studies targeting patients with at least one chronic medical condition and depression demonstrated significant improvement in depression symptoms (ranging from 9.2 to 48.7% improvement). Of the six studies that focused on high utilizers, two showed small reductions in utilization. The quality of the research methodology in most of the studies (12/15) was rated fair or poor. CONCLUSIONS: Interventions were more likely to be successful when patients were selected based on having at least one chronic medical condition and concurrent depression, and when patient-reported outcomes were assessed. Future research should focus on the role of mental health in complex care management, finding better methods for identifying patients who would benefit most from care management, and determining which intervention components are needed for which patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-2881-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-57912002018-02-08 A systematic review of care management interventions targeting multimorbidity and high care utilization Baker, Jennifer M. Grant, Richard W. Gopalan, Anjali BMC Health Serv Res Research Article BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the following three patient groups: adults with two or more chronic medical conditions, adults with at least one chronic medical condition and concurrent depression, and adults identified based solely on high past or predicted healthcare utilization. METHODS: Eligible studies were identified from PubMed, published between 06/01/2005 and 05/31/2015, and reported findings from a randomized intervention that tested a comprehensive, care management intervention. Identified interventions were grouped based on the three “complex” categories of interest (described above). Two investigators extracted data using a structured abstraction form and assessed RCT quality. RESULTS: We screened 989 article titles for eligibility from which 847 were excluded. After reviewing the remaining 142 abstracts, 83 articles were excluded. We reviewed the full-text of 59 full-text articles and identified 15 unique RCTs for the final analysis. Of these 15 studies, two focused on patients with two or more chronic medical conditions, seven on patients with at least one chronic medical condition and depression, and six on patients with high past or predicted healthcare utilization. Measured outcomes included utilization, chronic disease measures, and patient-reported outcomes. The seven studies targeting patients with at least one chronic medical condition and depression demonstrated significant improvement in depression symptoms (ranging from 9.2 to 48.7% improvement). Of the six studies that focused on high utilizers, two showed small reductions in utilization. The quality of the research methodology in most of the studies (12/15) was rated fair or poor. CONCLUSIONS: Interventions were more likely to be successful when patients were selected based on having at least one chronic medical condition and concurrent depression, and when patient-reported outcomes were assessed. Future research should focus on the role of mental health in complex care management, finding better methods for identifying patients who would benefit most from care management, and determining which intervention components are needed for which patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-2881-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-30 /pmc/articles/PMC5791200/ /pubmed/29382327 http://dx.doi.org/10.1186/s12913-018-2881-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Baker, Jennifer M.
Grant, Richard W.
Gopalan, Anjali
A systematic review of care management interventions targeting multimorbidity and high care utilization
title A systematic review of care management interventions targeting multimorbidity and high care utilization
title_full A systematic review of care management interventions targeting multimorbidity and high care utilization
title_fullStr A systematic review of care management interventions targeting multimorbidity and high care utilization
title_full_unstemmed A systematic review of care management interventions targeting multimorbidity and high care utilization
title_short A systematic review of care management interventions targeting multimorbidity and high care utilization
title_sort systematic review of care management interventions targeting multimorbidity and high care utilization
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791200/
https://www.ncbi.nlm.nih.gov/pubmed/29382327
http://dx.doi.org/10.1186/s12913-018-2881-8
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