Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis
Authors : A L Huntley, R Johnson, A King, R W Morris, S Purdy
Abstract
Objectives
The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, 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 while 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 coordinated multicomponent 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 healthcare resources.
Results
22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) 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. 9 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.
Citation: A L Huntley, R Johnson, A King, R W Morris, S Purdy Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis
BMJ Open 2016;6:e010933 doi:10.1136/bmjopen-2015-010933
Received: 22 December 2015 Revised: 24 March 2016 Accepted: 15 April 2016 Published: 10 May 2016
Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Contributors
ALH is the main systematic reviewer, and worked across all stages of the review from inception to completed draft. RJ is the cardiology and primary care expertise, and worked on screening, selection of studies, commenting on analysis, and development and checking of final document content. AK is the second reviewer, involved in screening, selection, data checking and commenting on developing and final document content. RWM is the statistical expertise, advising on data analysis and commenting on the developing and final document content. SP is the primary care and admission avoidance expertise, and advised throughout project, third reviewer for screening process and commenting on the developing and final document content.
Funding
This project was funded by the National School of Primary Health Care project no.238.
Competing interests None declared.
