Abstract
Objectives The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).
Setting CM initiated either whilst as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.
Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.
Intervention CM based on nurse co-ordinated multi-component care which is applicable to the primary care based health systems.
Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary health care resources.
Results Twenty-two studies were included: 17 RCTs and five NRCTs. Seventeen studies described hospital-initiated CM (n=4794) and five described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 [95%CI 0.60, 0.92] p=0.008) and LOS (mean difference -1.28 days [95%CI -2.04,-0.52] p=0.001) in favour of CM compared to usual care. Nine trials described cost data of which six reported no difference between CM and usual care. There were four studies of community-initiated CM versus usual care (2RCTs and 2NRCTs) with only the 2 NRCTs showing a reduction in admissions.
Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. Nine trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.
Protocol registration No
Strengths of review- High quality systematic review- Interventions examine nurse-led multicomponent care of heart failure patients- Focus on use of resources specific to heart failure
Limitations of review- Community-initiated case management trials were limited in quantity and were mostly of low quality.- Lack of cost data in most trials
Setting CM initiated either whilst as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.
Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.
Intervention CM based on nurse co-ordinated multi-component care which is applicable to the primary care based health systems.
Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary health care resources.
Results Twenty-two studies were included: 17 RCTs and five NRCTs. Seventeen studies described hospital-initiated CM (n=4794) and five described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 [95%CI 0.60, 0.92] p=0.008) and LOS (mean difference -1.28 days [95%CI -2.04,-0.52] p=0.001) in favour of CM compared to usual care. Nine trials described cost data of which six reported no difference between CM and usual care. There were four studies of community-initiated CM versus usual care (2RCTs and 2NRCTs) with only the 2 NRCTs showing a reduction in admissions.
Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. Nine trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.
Protocol registration No
Strengths of review- High quality systematic review- Interventions examine nurse-led multicomponent care of heart failure patients- Focus on use of resources specific to heart failure
Limitations of review- Community-initiated case management trials were limited in quantity and were mostly of low quality.- Lack of cost data in most trials
| Original language | English |
|---|---|
| Article number | e010933 |
| Number of pages | 26 |
| Journal | BMJ Open |
| Volume | 6 |
| Issue number | 5 |
| Early online date | 10 May 2016 |
| DOIs | |
| Publication status | Published - May 2016 |
Keywords
- Systematic review
- meta-analysis
- Heart Failure
- case management
- Hospital admissions
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Dr Rachel A Johnson
- Bristol Medical School (PHS) - NIHR Clinical Lecturer in Primary Health Care
- Bristol Population Health Science Institute
- Centre for Academic Primary Care
Person: Academic , Member