Table 15Summary of reviews with partial focus on care coordination interventions

ReferencePurposeResults
Adli 2006273 To discuss algorithm-guided treatment for depressionThis review evaluated the effectiveness of algorithm-guided care; it included four studies on collaborative care that used algorithms to guide treatment. All studies showed improvement in different outcomes measured (e.g., symptoms, greater satisfaction with care and higher attrition rates).
Aminzaadeh 2002275 To assess use of emergency department by older adults, risk factors associated with adverse health outcomes, and the effectiveness of intervention strategiesThis review was primarily an epidemiologic review looking at the use of emergency departments (ED) by older adults; it also included the risk factors to determine ED use. One section of the review focused on interventions such as comprehensive geriatric evaluation (5 articles) and coordinated discharge planning to improve ED use; however, the data were inconclusive about the effectiveness of these strategies.
Andrews 2004267 To explore the roles of community health workers and their effectiveness in conducting research with ethnic minority womenThe review investigated using community health workers in research with ethnic minority women. In reviewing their roles, there were 4 articles that considered community health workers as case managers but this was integrated with their other roles as educators or outreach workers. The authors reported that “using community health workers as case managers was more successful in retaining subjects than using them for outreach only”
Ara 2004262 To evaluate the effectiveness of cardiovascular disease management programs in managed care populationsThe different interventions included in the different disease management programs suggest some effectiveness in improving outcomes for cardiovascular diseases. The specific interventions that demonstrated effectiveness included case management, physician reminders and feedback, patient education and self-management. Specifically for CHF disease management programs, case management and intensive patient monitoring were effective strategies.
Badamgarav 2003263 To evaluate the effectiveness of disease management programs for depressionThis review searched for disease management programs for depression; however, it included several different interventions, of which multidisciplinary teams were one component. The review, however, did not specifically provide results for the effectiveness of multidisciplinary teams on outcomes but provided results for disease management programs as a whole. Overall, the pooled results indicated statistically significant outcomes for patients with depression who received disease management programs. The results also indicated that these programs can increase treatment costs.
Bijl 2004266 To evaluate the effectiveness of disease management programs in recognizing, diagnosing and treating major depressionThe review did not define disease management. Only one of the 6 included studies met our definition for care coordination. That study showed improvements in the intervention group for the outcomes reported: reductions of depressive symptoms [OR 3.45 (95% CI: 2.71–4.38)]; higher rates of treatment [2.98 (2.34–3.79)]; more satisfaction with care; lower depression severity; less functional impairment and greater quality of life.
Campbell 1999276 To review the effectiveness and problems of programs providing cancer care in rural and remote areasThis review searched for all programs providing rural cancer care services. Programs with shared care of patients in rural areas between primary care physicians and specialists in cancer care were included in the review. The review was unable to make any recommendations about the provision of shared care services for cancer in remote and rural areas due to the limitations of article designs and the variability of outcomes reported.
Crawford 2004252 To identify factors that promote or impede continuity of care for patients with severe mental illnessMost of the evidence in this review came from qualitative articles that identified factors that are important for continuity of care. Meta-analyses of care coordination interventions such as case management, assertive community treatment and community mental health teams suggest that use of such interventions can decrease the likelihood that patients will lose contact with services.
Dennis 2004251 To assess the effectiveness of interventions to prevent postpartum depressionOnly one article in the review reported on an element of care coordination: team midwifery. There were no significant differences between the two groups (team midwifery versus standard care) with respect to depression scores. There was insufficient evidence to recommend any of the interventions studied.
Draper 2000255 To evaluate the outcomes of acute service delivery to older people with mental disordersThis review provided on overview of the provision of old age psychiatry services in the hospital and the community. One section reported results from 5 randomized controlled trials that provided these services in a community setting. These results indicate that community old age psychiatry services are effective.
Druss 2006256 To evaluate interventions to improve general medical care in patients with mental and addictive disordersThe review provided an overview of all interventions designed to improve medical care. One study included a case manager and one included a multidisciplinary team with a facilitated referral to the community. The first study reported an improvement in the physical score of the SF-36 in the intervention group; the second study reported no difference between groups.
Duffy 2004250 To assess the evidence on nonpharmacological strategies for heart failure managementThis review assessed all nonpharmacological approaches to heart failure management, including those that were not specifically related to care coordination. Eight of the 15 included articles appeared to have some element of care coordination: multidisciplinary or case management. Overall, there appeared to be improvement in quality of life and hospital admissions in those articles with a care coordination component.
Eastwood 1996277 To assess the effectiveness of different methods of organization of asthma careThe review evaluated different methods of organizing asthma care, one of which was shared care between general practitioners and specialists. Only 1 of the 27 included articles reported this intervention and suggested that the effectiveness of shared care is comparable to conventional outpatient care. Overall, the review reported a lack of conclusive evidence favoring any particular way of organizing asthma care.
Gilbody 2003269 To evaluate the effectiveness of educational and organizational interventions to improve the management of depressionImproved treatment adherence and/or improved depression outcomes were seen with the more complex interventions: collaborative care, quality improvement (both organizational and educational interventions included), case management, pharmacist-provided information and education, guideline implementation strategies that were accompanied by complex organizational interventions.
Gonseth 2004260 To assess the effectiveness of disease management programs in reducing hospital re-admission among elderly patients with heart failureThis review included all disease management programs; however, only 8 of the 54 included articles reported some element of care coordination. The effectiveness of these specific articles was not analyzed. Overall, meta-analysis of 27 RCTs showed significant decrease in re-admission for heart failure or cardiovascular cause [RR 0.70, (95% CI: 0.62–0.79], all-cause readmission [0.88 (0.79–0.97)] and readmission or death [0.82 (0.72–0.94)] for participants in disease management programs compared to usual care. 10 of these articles estimated costs and results indicated that the implementation of a disease management program was cost-effective. Similar results were observed in the non-randomized trials. These results were observed among a heterogeneous group of patients and in diverse health care systems.
Griffin 1998274 To assess the effectiveness of general practice versus hospital care for diabetesThis review included “shared care” as an intervention strategy; however, this was not defined. Two of the 5 included articles reported some element of care coordination; however, the review did not analyze the effect of this on outcomes. Overall, the review reported the effectiveness of computerized recall with prompting in improving outpatient care in the short term.
Halcomb 2004268 To describe the role of practice nurses in heart failure managementThe authors identified two articles in which nurses played a role in coordinating care as part of a multifaceted intervention. Care coordination promoted follow up and decreased hospitalization but did not affect health outcomes.
Handford 2006257 To assess the effectiveness of the setting and organization of care on outcomes among patients living with HIV/AIDSThe authors identified three studies evaluating case management and six studies evaluating either multidisciplinary or multi-faceted care. Case management was defined differently for each study but always included a distinct case manager; multidisciplinary care involved use of two or more providers other than standard clinician; multi-faceted care was the use of two or more treatment programs other than standard clinician care. All three case management studies showed improvements in selected outcomes (mortality, medication use, continuity of care); one study showed no difference in health care utilization use. Multidisciplinary or multi-faceted care studies showed mixed results for use of medications and health care utilization with some studies associated with increased used of medications and others not.
Harding 2005249 To assess the effectiveness of different models of providing palliative care on outcomes for patients with HIV/AIDSThe review included all models of palliative care and did not search specifically for care coordination interventions. 15 of the included 34 articles had some element of care coordination: multidisciplinary teams, case management, integrated care. However, because the analysis did not focus specifically on the coordination elements, it is not possible to draw any conclusions about the effect of care coordination on patient outcomes. Overall, the evidence indicated that palliative care at home and inpatient hospice significantly improved pain and symptom control, insight, spiritual well-being and anxiety.
Harvey 2001278 To determine the effectiveness of existing interventions in improving health professionals' management of obesity or patient outcomesThe review searched for interventions aimed at professionals (e.g., education, reminders) as well as organizational interventions (e.g., multidisciplinary teams). Only one article that primarily addressed organizational interventions was included. This article aimed at improving collaboration between general practitioners and a hospital based obesity clinic through shared care and integration of services. This article “indicated some positive effects in the short term....but these were not sustained over the long term”
Hastings 2005279 To assess the effectiveness of interventions aimed at improving outcomes for elderly patients discharged from the emergency department (ED)The review included five observational, descriptive studies and six RCTs that met our definition for care coordination. Of these, three RCTs reported improvements in functional status of intervention patients. All three studies included use of a specially trained nurse to perform geriatric assessment and home-based care. The review also reports that the targeting of high risk patients may result in interventions being more effective.
Heideman 2005258 To assess effectiveness of interventions aimed at improving diagnosis and management of patients with anxiety disorders by general practitioners (GP)The review assessed the effectiveness of professional and organizational interventions to improve care for patients with anxiety disorders. It included two studies on collaborative care; one of which appeared to have a positive effect on anxiety outcomes. The intervention for this study included a psychologist working collaboratively with the GP to provide care.
Hwang 2005259 “To summarize the existing evidence on interventions to improve health-related outcomes in homeless people”The review studied all interventions assessing health-related outcomes among homeless people. It included 13 studies that had some component of case management and 6 studies that included the use of assertive community treatment teams. Overall, the review reported improved outcomes among interventions providing coordinated treatment and support.
Ingersoll 2005271 To summarize the literature on the role of nurses as care coordinators or case managers for patients with diabetesOverall, there were 9 included studies; however, only 4 studies involved care coordination with multiple providers. The remaining 5 studies were substitution studies with nurses providing care instead of physicians. The care coordination studies showed improvements in the respective outcomes studied (HbA1c, hospital admissions). One study intervention involved the referral of patients by primary care physicians to specialist care and showed significant decreases in mean HbA1c levels of 1.75 (95%CI: 1.4%-1.9%).
Mitchell 2002253 To examine factors related to the delivery of palliative care by general practitionersThe review provided an overview of general practitioner (GP) provision of palliative care, including their self-assessment and training. There was only one paragraph of the review that briefly addressed the importance of having GPs be a part of a palliative care team and suggested that when GPs and specialists work together there is an improvement in “diagnostic accuracy, application of evidence-based treatments, identification of systematic problems in the delivery of care, and improved ability to facilitate deaths at home.”
Ofman 2004261 To assess the effects of disease management programs in patients with chronic disease58 of 102 (56% of the included articles) used multidisciplinary teams as a strategy for care; however, the specific effect of this strategy was not reported. Disease management programs incorporating different strategies such as patient education, provider education, reminders and provider feedback, appeared to be beneficial for diabetes, depression, hypertension, coronary artery disease, and hyperlipidemia. Less benefit was shown for COPD and chronic pain.
Pearson 2003264 To assess the effectiveness of interventions to improve medication use in managed care settingsThe review included articles with several interventions (including education, disease management, feedback) with most articles having multiple components. 25 of the 48 included articles reported disease management as the primary strategy. Disease management programs that focused primarily on depression and diabetes were effective in changing processes of care and improving short-term outcomes. These results did not extend to those articles that examined outcomes beyond 12 months.
Phillips 2004270 To evaluate the efficacy of comprehensive discharge planning and postdischarge support on outcomes among older patients with CHF12 of the 18 included articles reported some element of care coordination: increased communication between providers, coordination of home care and case management. Interventions involving home visits or extended care services were associated with significantly lower readmission rates. The results should be interpreted with caution due to quantitative heterogeneity among articles within intervention effects.
Renders 2001254 To assess interventions targeting health care professionals or the health care system on the management of diabetesThis review examined a variety of interventions to improve diabetes management that target providers and the organization. Included in the interventions were some articles that had some element of care coordination: multidisciplinary teams or case management. However, these components were combined with other strategies such as education or follow-up, making it difficult to assess the effect of the care coordination component on outcomes. Most articles that included these care coordination components as part of the intervention showed improved outcomes.
Sin 2003265 To evaluate the effects of anti-COPD therapies (pharmacological and nonpharmacological) on patient outcomesThe review evaluated several commonly used anti-COPD therapies, including disease management programs. 8 of the included articles addressed disease management and the interventions mostly focused on education, self-management and follow-up. The intent of the disease management programs was to integrate and coordinate care. Overall, there was insufficient evidence to support the efficacy of disease management programs for patients with COPD.
Vergouwen 2003272 To assess the effectiveness of interventions to improve adherence to antidepressant medications9 of the 11 collaborative care articles showed significantly improved adherence and depression outcomes in the intervention group vs. the control group. Most of the collaborative care interventions included components (such as increased patient education, treatment training, longer and more frequent visits) targeting the patient, physician and the health care system so it was not possible to know which components accounted for improved adherence.
Weingarten 2002148 To evaluate the effectiveness of disease management programs for chronic diseasesThe authors searched for articles evaluating disease management programs and then classified the different components of the intervention (e.g., patient education, provider education, reminders). None of the intervention components had a clear care coordination focus. Overall, the review reported that all of the interventions showed improvements in disease control and provider adherence to guidelines.

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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