Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data.
OBJECTIVE
To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people.


METHODS
Practice level before and after analysis of hospital admissions data with control group.


METHODS
Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission.


METHODS
Rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out).


RESULTS
The intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval -5.7% to 38.7%), emergency bed days (increase 19.0%, -5.3% to 43.2%), and mortality (increase 34.4%, -1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged > or =65 effects on the rates of emergency admission (increase 2.5%, -2.1% to 7.0%), emergency bed days (decrease -4.9%, -10.8% to 1.0%), and mortality (increase 5.5%, -3.5% to 14.5%) were also non-significant.


CONCLUSIONS
Case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.
Gravelle
Hugh
H
National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO10 5DD.
Dusheiko
Mark
M
Sheaff
Rod
R
Sargent
Penny
P
Boaden
Ruth
R
Pickard
Susan
S
Parker
Stuart
S
Roland
Martin
M
D000368:Aged; D001509:Bed Occupancy; D019090:Case Management; D016022:Case-Control Studies; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards; D004630:Emergencies / Q000453:epidemiology*; D004739:England; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards; D006760:Hospitalization; D006801:Humans; D009026:Mortality; D013222:State Medicine / Q000458:organization & administration / Q000592:standards; D016896:Treatment Outcome