Description of Treatment/Procedure

Case management is defined in this report as a set of activities whereby the needs of populations of patients at risk for excessive resource utilization, poor outcome, or poor coordination of services are identified and addressed through improved planning, coordination, and provision of care. The activities are proactive and are continuous over an extended period of time involving different care settings and providers. The evidence is almost exclusively from studies of nursing case management. The overall aim is to optimize outcome and minimize waste of resources.

Committee Summary

With regard to case management, the ICSI Technology Assessment Committee finds that:

1. Case management programs for high-risk patients with chronic illness resulted in decreased hospital admissions, lengths of stay, readmissions, and emergency department visits. Quality of life was improved and patients were better able to manage their symptoms. Costs were also decreased. (Classes A and C evidence)
   
2. For the frail elderly, case management increased survival. Patients experienced increased functional ability without increased use of health services. (Classes A and M evidence)
   
3. Following acute MI, case management had little effect in decreasing stress but did reduce risk factors. (Class A evidence)
   
4. For patients with a mix of acute and chronic illnesses, in one particular program, case management appeared to lead to decreased admissions and inpatient days although the criteria used to define the patients in the program were not specified. (Class D evidence)
   
5. Common elements in effective case management programs included comprehensive initial assessment, development of a specific care plan, a constant caregiver, patient education, and home visits.
   
6. Although case management is efficacious as demonstrated in many of the reported trials discussed in this report, the difficulty in identifying patients best served by case management and the lack of consensus on what constitutes an optimal case management program may influence the effectiveness in a clinical setting. A technically correct and rigorous cost-effectiveness analysis has not been performed.