Table 14aSummary of reviews with entire focus on care coordination interventions: mental health

ReferencePurposeCare coordination intervention and definitionNo. of articlesResultsLimitations to usefulness of review
Bower 2000208 To assess the effect on primary care provider behavior of adding an onsite mental health worker On-site mental health worker: services provided by an on-site MHW were a separate activity and not part of normal primary care consultations; the PCP and MHW work for at least part of the time as part of the same clinical team38The addition of a mental health worker to the primary care team did not have any significant effects on provider behavior. The evidence did not support the addition of a mental health worker to a primary care team with the intent of changing provider behavior.None
Craven 2006209 To identify better practices in collaborative care for mental health Collaborative care: “involves providers from different specialties, disciplines, or sectors working together to offer complementary services and mutual support, to ensure individuals receive the most appropriate service from the most appropriate provider in the most suitable location, as quickly as necessary, with a minimum of obstacles. Collaboration can involve better communication, closer personal contacts, sharing of clinical care, joint educational programs, and (or) joint program and system planning.”38The authors reported the following results: collaborative relationships at either a system-level or provider level require time, supportive structures and preparation; the degree of collaboration does not appear to predict outcomes; for collaboration to be effective, it should be paired with treatment guidelines; collaboration works best when clinicians and specialists are located in the same place; systematic follow-up was a strong predictor of positive clinical outcomes; patient choice about treatment may be important; and collaborative care interventions established as part of a research study may be difficult to sustain once the study is complete.Not possible to evaluate effectiveness of different elements of collaborative care
Gunn 2006210 To assess effectiveness of “system level” interventions for depression System level interventions: had to include ALL of the following: (1) multi-professional approach with a GP and at least one other health professional; (2) a structured management plan; (3) scheduled patient follow up; (4) enhanced inter-professional communication through team meetings, case-conferences, feedback between care-givers11Eight articles reported an increase in the proportion of patients recovering from depression in favor of the intervention group (range 10% to 33%); however the articles did not account for attrition rates ranging from 5% to 50%.No information on which elements of the intervention contribute to improved outcomes.
Latimer 1999211 To determine the economic impacts of the assertive community treatment model Assertive community treatment: “involvement of team medical personnel along with a case manager, team meetings to discuss treatment plans”34The most consistent effect of the assertive community treatment (ACT) model was the greater reduction in hospital use, particularly of programs that have higher fidelity to the ACT model. “Based on costs in Quebec, high-fidelity ACT can cut costs if patients averaged more than about 50 days hospitalization yearly”.Poorly described methods for article searches and inclusion/exclusion criteria.
Marshall 2000212 To determine the effectiveness of assertive community treatment (ACT) for severe mental disorders when compared to standard care, hospital-based rehabilitation and case management Assertive community treatment: a multidisciplinary team sharing responsibility for their patients who care exclusively for a group of patients; emphasizes team working and responsibility26Patients receiving ACT were more likely to remain in contact with services [OR: 0.51 (95% CI: 0.37–0.70)], were less likely to be admitted to a hospital [0.59 (0.41–0.85)], more likely to be living independently [0.46 (0.25–0.86)], less likely to become homeless [0.24 (0.08–0.65)], and less likely to be unemployed [0.31 (0.17–0.57)] when compared to standard community care. These findings were consistent when compared to hospital-based rehabilitation. There was insufficient data to allow for comparison to case management for patients remaining in contact with services and hospitalization. There was insufficient cost data; however, limited data suggests that ACT programs are expensive. Overall, the evidence suggested that ACT is effective in caring for mentally ill patients in the community.None.
There was insufficient data to allow for comparison to case management for patients remaining in contact with services and hospitalization. There was insufficient cost data; however, limited data suggests that ACT programs are expensive. Overall, the evidence suggested that ACT is effective in caring for mentally ill patients in the community.
Simmonds 2001213 To assess the benefits of community mental health team management in severe mental illness Community mental health team management: generic care (care not supplemented by assertive community treatment, intensive case management or other specific model) from a community-based multi-disciplinary team that provides a full range of interventions5Community mental health team management compared to standard care was associated with fewer deaths by suicide or suspicious circumstances, lesser loss to follow-up, reduced hospital stay, and reduced costs. The intervention showed no impact on social functioning.None
Wadhwa 1999214 Do multidisciplinary teams, case management, and outreach or home care improve the quality of care for vulnerable populations Multidisciplinary teams: “comprehensive care is delivered through the coordinated action of a diverse collection of health care populations”3These interventions did not consistently demonstrate improvements in functional, clinical or psychological outcomes. Multidisciplinary outreach strategies were effective in reducing in-patient hospitalizations among mentally ill patients. Aggressive case management models also appeared to be beneficial to mentally ill patients.None
Case management: “a health care professional who works with the patient and families”6Satisfaction among patients and care givers was higher among these interventions. There was insufficient cost data provided in the articles.
Ziguras 2000215 To evaluate the effectiveness of case management in mental health Assertive community treatment: authors recorded the definition provided in each article28Both assertive community treatment and clinical case management had positive effects on family burden, family satisfaction and costs of care. While clinical case management increased total number of admissions, it also decreased the total length of stay in the hospital. However, with assertive community treatment the total number of admissions and the proportion of clients hospitalized were reduced. Overall, assertive community treatment was more effective in reducing hospitalization compared to clinical case management.None
Clinical case management: no specific definition; authors recorded the definition provided in each article.16
Neumeyer-Gromen 2004223 To assess the effectiveness and cost-effectiveness of disease management programs for depression Disease management: the program had to include all the following components: patient self management education, provider education, collaborative care, routine reporting and regular feedback between different professions, interdisciplinary discussion of treatment options and supervision by specialists10Disease management programs (DMPs) when compared with usual primary care, significantly improved depression severity [RR 0.75 (95% CI: 0.70–0.81)], adherence to treatment regimen [0.59 (0.46–0.75)] and patient [0.57 (0.37–0.87)] and provider satisfaction. This finding was applicable across different degrees of depression, settings and US populations. DMPs can be considered cost-effective (costs per QUALY: $9,051 to $49,500). The effectiveness of single elements within the programs could not be assessed since the research question aimed at answering the effectiveness of DMPs which included all components in a comprehensive care strategy.None
Gorey 1998231 To assess the effectiveness of case management for mentally ill patients Case management: “outreach, identification, assessment and service planning, service linkage and monitoring, advocacy”24Among articles assessing functional status, prevention of re-hospitalization and quality of life, approximately three-quarters of patients in a case management program had better outcomes than those not in such programs. Also, approximately three-quarters of case managed care plans cost less than the average comparison care plan. Case load accounted for half of the variability observed in case management's effectiveness.No detail on inclusion/exclusion criteria provided.
Marshall 1998232 To assess the effectiveness of case management “as an approach to caring for severely mentally ill people in the community” Case management: “means of coordinating services”; by a single case manager who is expected to assess that person's needs, develop a care plan, arrange for suitable care to be provided, monitor the quality of the care provided, and maintain contact with the person11Patients receiving case management were more likely to remain in contact with psychiatric services, though the effect size was small. Case management approximately doubled the rate of hospital admissions when compared to standard care. In one trial, case management found a significant increase in medication compliance, otherwise it appeared unlikely that case management showed substantial improvement in clinical or social outcomes.None
The effect of case management on costs must be interpreted with caution; while it appears that case management increases costs to health care providers, it may reduce cost to society. Overall, the authors believe that case management is a poor alternative to standard care “because a small advantage in numbers remaining in care is off-set by a large increase in admission rates, no obvious clinical gains and considerable uncertainty over costs.”
Jeffery 2000235 To evaluate the effectiveness of different approaches to treating patients with problems of severe mental illness and substance misuse Integrated care programs: programs where substance misuse treatment was integrated with psychiatric care and care was provided by the same personnel team6The review looked at complex patients: patients with severe mental illness who also had problems with substance misuse. There was no clear evidence that integrated programs have different outcomes compared to programs providing psychiatric treatment alone. There was also no evidence that any particular type of integrated program was better than the others studied. However, one article found that a residential integrated program was more likely to retain patients than a non-residential program.No definition of case management intervention
Case management: not defined but included a specialized five-hour per week substance misuse treatment group1Overall, there was no clear evidence that integrated care for patients with substance misuse and severe mental illness can lead to better or worse outcomes.
Reeves 2001238 To assess the effect of interprofessional education on the care of adults with mental health problems Interprofessional education: “when two or more professionals learn interactively together with the object of promoting collaborative practice”19All of the articles showed an improvement in the outcomes studied regarding provider education; however the author notes that the quality of the included articles was generally poor and so the evidence relating to the effectiveness of interprofessional education can be considered “patchy”.Outcomes related to provider education and not specifically patient care.

From: 4, Review of Systematic Reviews of Care Coordination Interventions

Cover of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination).
Technical Reviews, No. 9.7.
McDonald KM, Sundaram V, Bravata DM, et al.

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