title: Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.
abstract: BACKGROUND
  Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population.
  
  
  METHODS
  We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated.
  
  
  RESULTS
  Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes.
  
  
  CONCLUSIONS
  Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Bleich
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Sherrod
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Anne
authors.initials: A
authors.lastname: Chiang
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Boyd
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wolff
authors.forename: Eva
authors.initials: E
authors.lastname: DuGoff
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Eva
authors.initials: E
authors.lastname: Chang
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Salzberg
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Keely
authors.initials: K
authors.lastname: Anderson
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.affiliation: Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Room 302, Baltimore, MD 21205. Email: ganderson@jhu.edu.
authors.forename: Gerard
authors.initials: G
authors.lastname: Anderson
mesh_terms: D019090:Case Management; D002908:Chronic Disease / Q000191:economics*; D006233:Persons with Disabilities; D019468:Disease Management; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D014481:United States