The objective of this systematic review is to synthesise the best available evidence on the effectiveness of case management for adult patients with chronic liver disease.
The search strategy aims to find both published and unpublished studies from January 1960 to May 2012 in English and Chinese languages. A three-step search strategy will be utilised in this review. An initial limited search of PubMed and CINAHL Plus with full text will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. A second search using all identified keywords and index terms will then be undertaken (Appendix I). Thirdly, the reference list of all identified reports and articles will be searched for additional studies.
The databases to be searched will include:
CINAHL Plus with Full Text
Academic Search Complete
Cochrane Central Register of Controlled Trials (CENTRAL)
DARE (Database of Abstracts of Reviews of Effectiveness)
Chinese Electronic Periodical Services (CEPS)
The databases to be searched for unpublished studies will include:
ProQuest Dissertations and Theses
Types of study to be included
Randomised controlled trials (RCTs) will be considered for inclusion to enable the identification of current best evidence. If there are too few RCTs, controlled clinical trials, cohort and case-control studies will also be considered for inclusion.
Condition or domain being studied
Chronic liver disease (CLD) is one of the leading causes of human morbidity and mortality. The dominant aetiologies of chronic liver disease are viral infection and non-alcoholic fatty liver disease in most countries, while alcoholic liver disease is a particular problem in western countries. Because of disease progression, some CLD patients may develop liver cirrhosis or hepatocellular carcinoma in the disease course.
Case management includes assessment, planning, implementation, cooperation, quality control, and service evaluation to determine the level of patient satisfaction with health care provided. Under the case management model, the patient is managed by a nurse who is responsible for that patient’s treatment and liaises with other specialists about their care. Case management aims to improve quality of care and patients’ overall satisfaction with nursing care.
This review will consider adult patients aged over 16 years, with a clinical diagnosis of chronic liver disease (CLD) at any stage, including hospital-based case management participants. CLD will be defined as those who had HCV-antibody or HBsAg positive for more than six months, elevated serum alanine aminotransferase level, clinically compensated or decompensate liver cirrhosis, hepatocellular carcinoma (HCC) either confirmed by liver histology or typical image studies. The exclusion criteria will include the following: patients with a coexisting chronic debilitating illness such as end-stage renal disease, stroke, inflammatory bowel disease, epilepsy, mental illness and malignancies other than HCC.
This review will consider any studies with a focus on case management interventions predominantly aimed at improving care coordination and nursing care quality of CLD patients including health education and program, social support, and integration of primary care and specialist management and disease management. This review will focus on coordination of multidisciplinary care and the integration of this with patients’ needs. We anticipate that such studies will generally have used a validated QOL tool to evaluate the effect of the case management intervention on patients’ quality of life.
The outcomes will include, but are not limited to:
1. Quality of care, as measured by self-designed evaluation questionnaires, e.g. awareness of disease, and satisfaction of health education, and patients’ overall satisfaction
2. Quality of life, as measured with any validated QOL instrument, such as generic (SF-36) and disease-specific scales (Chronic Liver Disease Questionnaire) of HRQOL
3. Hospitalisation costs, e.g. patients’ hospital stay
Data extraction, (selection and coding)
Quantitative data will be extracted from papers included in the review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Risk of bias (quality) assessment
Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the JBI-MAStARI. Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Strategy for data synthesis
Where possible, quantitative research study results will be pooled in statistical meta-analysis using the JBI-MAStARI. All results will be subject to double data entry. Odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible, the findings will be presented in narrative form.
Analysis of subgroups or subsets
If appropriate, the findings from this systematic review will inform Joanna Briggs Institute Best Practice Information Sheets, Evidence Summaries and Consumer Information Sheets.
Contact details for further information
Joanna Briggs Institute Synthesis Science Unit (JBI SSU)
Synthesis Science Unit (SSU)
The Joanna Briggs Institute
Faculty of Health Sciences
The University of Adelaide
Organisational affiliation of the review
The Taiwan Joanna Briggs Institute Collaborating Centre : A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan
Shu-Chuan Chang, The Taiwan Joanna Briggs Institute Collaborating Centre : A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan Yi-Chen Lin, The Taiwan Joanna Briggs Institute Collaborating Centre : A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan
Anticipated or actual start date
08 June 2012
Anticipated completion date
06 December 2013
The Central Taiwan University of Science and Technology
Conflicts of interest
Other registration details
The Joanna Briggs Institute PRO621
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Adult; Case Management; Chronic Disease; Humans; Liver Diseases
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.