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Outpatient Case Management for Adults with Medical Illness and Complex Care Needs Comparative Effectiveness Review Number 99

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Outpatient Case Management for Adults with Medical Illness and Complex Care Needs Comparative Effectiveness Review Number 99 Comparative Effectiveness Review Number 99 Outpatient Case Management for Adults With Medical Illness and Complex Care Needs Comparative Effectiveness Review Number 99 Outpatient Case Management for Adults With Medical Illness and Complex Care Needs Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10057-I Prepared by: Oregon Evidence-based Practice Center Portland, OR Investigators: David H. Hickam, M.D., M.P.H. Jessica W. Weiss, M.D., M.C.R. Jeanne-Marie Guise, M.D., M.P.H. David Buckley, M.D., M.P.H. Makalapua Motu'apuaka, B.S. Elaine Graham, M.L.S. Ngoc Wasson, M.P.H. Somnath Saha, M.D., M.P.H. ARHQ Publication No. 13-EHC031-EF January 2013 This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others— make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Hickam DH, Weiss JW, Guise J-M, Buckley D, Motu'apuaka M, Graham E, Wasson N, Saha S. Outpatient Case Management for Adults With Medical Illness and Complex Care Needs. Comparative Effectiveness Review No. 99. (Prepared by the Oregon Evidence- based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No.13- EHC031-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input from are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Christine Chang, M.D., M.P.H. Director Task Order Officer Evidence-based Practice Program Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments The researchers at the Evidence-based Practice Center would like to acknowledge the following people for their contributions. We are grateful to our Task Order Officer, Christine Chang, M.D., M.P.H., for her support and guidance in developing this report, and our Associate Editor, Meera Viswanathan, Ph.D., for her review of the report and meaningful comments. Key Informants and members of the Technical Expert Panel were instrumental in the formation of the parameters and goals of this review. We would also like to thank those who worked so conscientiously on the research team in searching the literature, retrieving and screening citations, extracting data, developing evidence tables, preparing figures, and editing the report—Martha Schechtel, R.N., Jessica Griffin, M.S., Andrew Hamilton, M.L.S., M.S., Robin Paynter, M.L.S., Basmah Rahman, M.P.H., Jesse H. Wagner, M.A., and Leah Williams. Finally, we thank Mark Helfand, M.D., M.P.H., for his insights, editorial review, and continued support. Key Informants Charles Boult, M.D, M.P.H., M.B.A. Margaret Leonard, M.S., R.N.-B.C., F.N.P. Professor, Johns Hopkins School of Public President of the Board of Directors Health Case Management Society of America Director, Lipitz Center for Integrated Health Niskayuna, NY Care; the Eugene and Mildred Lipitz Professor in Health Care Policy Michael O’Dell, M.D., M.S.H.A., Baltimore, MD F.A.A.F.P. Kenneth S. Fink, M.D., M.G.A., M.P.H. Chair, Department of Family and Division Administrator Community Medicine Med-Quest Division, Hawaii State Medicaid University of Missouri–Kansas City Kapolei, HI Kansas City, MO David Labby, M.D. Lois Wessel, R.N., C.F.N.P. Medical Director Associate Director for Programs Care Oregon Association of Clinicians for the Portland, OR Underserved Tysons Corner, VA iv Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design and/or methodological approaches do not necessarily represent the views of individual technical and content experts. Dena M. Bravata, M.D., M.S. Kathryn M. McDonald, M.M. Affiliate and Investigator Executive Director, Senior Scholar Center for Health Policy, Stanford Center for Health Policy, Stanford University University Stanford, CA Stanford, CA Charles Boult, M.D, M.P.H., M.B.A. Hussein A. Tahan, D.N.Sc., R.N. Professor, Johns Hopkins School of Public Consultant Health International Health Care Management & Director, Lipitz Center for Integrated Health Consulting Care; the Eugene and Mildred Lipitz Secaucus, NJ Professor in Health Care Policy Baltimore, MD Edward H. Wagner, M.D., M.P.H., FACP Director Kenneth S. Fink, M.D., M.G.A., M.P.H. Group Health Cooperative of Puget Sound Division Administrator Senior Investigator of the MacColl Institute Med-Quest Division, Hawaii State Medicaid Seattle, WA Kapolei, HI Margaret Leonard, M.S., R.N.-B.C., FNP President of the Board of Directors Case Management Society of America Niskayuna, NY v Peer Reviewers Thomas Bodenheimer, M.D., M.P.H. Pamela Mitchell, Ph.D., R.N. Adjunct Professor Professor Emeritus University of California, San Francisco University of Washington School of Nursing RWJ Foundation Seattle, WA San Francisco, CA Cheryl Schraeder, Ph.D., R.N. Matthew Burke, M.D. Clinical Associate Professor Senior Clinical Advisor University of Illinois at Chicago Health Resources and Services Mahomet, IL Administration Rockville, MD Hussein A Tahan, D.N.Sc., R.N. Consultant Neil Kirschner, Ph.D. International Health Care Management & Senior Associate Consulting Regulatory and Insurer Affairs Secaucus, NJ American College of Physicians Washington, DC Margaret Leonard, M.S., R.N.-B.C., FNP President of the Board of Directors Case Management Society of America Niskayuna, NY vi Outpatient Case Management for Adults With Medical Illness and Complex Care Needs Structured Abstract Objectives. In this evidence review we evaluated outpatient case management (CM) as an intervention strategy for chronic illness management. We summarized the existing evidence related to the effectiveness of CM in improving patient-centered outcomes, quality of care, and resource utilization in adults with chronic medical illness and complex care needs. We also assessed the effectiveness of CM according to patient and intervention characteristics. Data sources. Articles were identified from searches of the MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects.
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