A meta-analysis of the effect of hospital-based case management on hospital length-of-stay and readmission.
BACKGROUND
Although many hospital-based case management (CM) interventions have been studied, there is little work summarizing the effectiveness of these studies.


OBJECTIVE
The purpose of this study was to investigate the effect of hospital-based CM compared with usual care on length of hospital stay and readmission rate.


METHODS
A meta-analytic method was employed to analyze the effect sizes of CM intervention on outcomes. Eligible studies were retrieved using computerized database searches, footnote chasing, and contact with content experts. The authors reviewed the final 12 studies, and the effect size, 95% confidence interval (CI), sensitivity, homogeneity, and publication bias were analyzed.


RESULTS
The overall average weighted effect size on length of stay (LOS) was 0.094 with a 95% CI of -0.032 to 0.220. The overall odds ratio for readmission was 0.87 with a 95% CI of 0.69 to 1.04. Overall, hospital-based CM interventions were not significantly effective in reducing LOS and readmissions. However, CM for patients with heart failure (effect size of 0.241 with a 95% CI of 0.012 to 0.470) was significantly effective in reducing LOS, although it was not effective for stroke patients (effect size of -0.226 with a 95% CI of -0.542 to 0.089) and frail elders (effect size of 0.126 with a 95% CI of -0.073 to 0.324). Analysis indicated that in this meta-analysis publication bias was unlikely.


CONCLUSIONS
The findings of this meta-analysis demonstrate a 6% decrease in readmission rate for patients who received hospital-based CM interventions. Further meta-analytic studies are needed to investigate the effectiveness of CM on other outcomes.
Kim
Young-Ju
YJ
School of Nursing, University of Maryland, Baltimore, 21201, USA. ykim007@son.umaryland.edu
Soeken
Karen L
KL
D000368:Aged; D015982:Bias; D019090:Case Management / Q000458:organization & administration*; D016001:Confidence Intervals; D016638:Critical Illness / Q000628:therapy; D015987:Effect Modifier, Epidemiologic; D004827:Epilepsy / Q000628:therapy; D016330:Frail Elderly / Q000706:statistics & numerical data; D006302:Health Services Research / Q000458:organization & administration; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012680:Sensitivity and Specificity; D020521:Stroke / Q000628:therapy