title: Analysis of case management programs for patients with dementia: a systematic review.
abstract: BACKGROUND
  People suffering from dementia are particularly vulnerable to the gaps between the health and social service systems. Case management is a professional field that seeks to fill in these gaps and remedy this fragmentation.
  
  
  METHODS
  We report the results of a systematic literature review of the impact of case management programs on clinical outcomes and the utilization of resources by persons with dementia. We focused on randomized controlled trials (RCTs) and attempted to identify the factors that might contribute to greater program efficacy. Because the evaluation methods in these studies varied, we used the effect size method to estimate the magnitude of the statistically significant effects reported.
  
  
  RESULTS
  Our search strategy identified 17 references relating to six RCTs. Four of these six RCTs reported moderately statistically significant effects (effect size, 0.2-0.8) on their primary end point: the clinical outcome in three and resource utilization in one. Two of the RCTs reported weak or no effects (effect size, <0.2) on their primary end point. Because of the wide variety of the end points used, an overall effect size could not be calculated. Parameters that appear to be related to greater case management efficacy are the integration level between the health and social service organizations and the intensity of the case management.
  
  
  CONCLUSIONS
  Integration and case management intensity seem to determine the magnitude of the clinical effects in this new professional field. Further studies are needed to clarify the economic impact.
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Gériatrie, Paris, France. dominique.somme@egp.aphp.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
authors.forename: Hélène
authors.initials: H
authors.lastname: Trouve
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.forename: Dominique
authors.initials: D
authors.lastname: Gagnon
authors.forename: Yves
authors.initials: Y
authors.lastname: Couturier
authors.forename: Olivier
authors.initials: O
authors.lastname: Saint-Jean
mesh_terms: D019090:Case Management / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care