Outpatient Case Management

There are a lot of good ideas for improving health care, but we don’t know if they work til comprehensive research is done to ascertain the effects of implementation.  And doing research is often not easy, so the absence of evidence doesn’t mean absence of benefit.  The Agency for Healthcare Research and Quality has commissioned a series of reviews of initiatives and the most recent looked at outpatient case management.   (AHRQ Report)   As is often the case, one difficulty in assembling the evidence is the lack of consistent definitions or consistent intervention techniques.  There were a total of 109 applicable studies reviewed, for a variety of illnesses, generally chronic.  The summary of the studies concluded that there was only a small change in quality outcomes, patient satisfaction or experience of care and health care utilization or spending, although some studies showed significant effects on one or more of these outcomes.  While care management interventions were diverse, some characteristics that appeared associated with better outcomes were more intense care management–longer contact times, longer duration of the intervention, face-to-face contacts and more integration with the patient’s usual sources of care.  Overall, one could conclude that case management has the potential to improve outcomes, but an optimal set of interventions for specific diseases or patient characteristics or situations has not yet been discovered.  Further research may uncover that set of interventions, which if consistently executed, would improve both quality and cost.