Randomised controlled trials (RCTs) of patient advocacy case management interventions were eligible for inclusion. This case management model was described as the comprehensive coordination of services across the continuum of care, viewed from a patient perspective. Participants were required to live in the community and to be either adults with a chronic somatic disease or older people who were frail or had impairment. Required outcomes were service use and costs. Studies of acute care, mental health care, substance abuse or discharge follow-up were excluded.
All studies in the review included frail or older people with conditions such as functional impairment, medical problems, dementia or frailty. Two studies also included younger participants with catastrophic and/or chronic illness or dementia. Mean age of study groups, where stated, ranged from 77 to 84 years. In most groups most participants were female (range 49% to 71%). Case managers were generally nurses or social workers (where stated), who worked either independently or as part of a multidisciplinary team. The mean caseload (where reported) was 60 patients (range 30 to 100). Interventions comprised a wide range of activities that involved patients, caregivers and/or health professionals; activities included screening, monitoring, planning, training, co-ordination and liaison. Usually the main patient contact method was home visiting and/or telephone calls. Controls received a differing case management model (where stated). Intervention duration was in most cases 12 months (range 10 to 36 months). Service-use outcomes reported in the review included visits or admissions to hospital, nursing home or emergency department and hospital length of stay; costs were expressed as price of healthcare. The studies were set in USA, Canada and Europe.
Two reviewers independently selected the studies. Disagreements were resolved by consensus or by discussion with a third reviewer.