CASE-MANAGEMENT PROGRAMS IN PRIMARY-CARE

To review the impact of case management programs on health care resour ce use; their impact on patient satisfaction, quality of life, and fun ctional status (patient-centered outcomes); and their cost-effectivene ss, we reviewed the English language literature utilizing the followin g MEDLINE and Health-STAR headings: case management, patient care plan ning, patient-centered care, disease management, care management, and managed care programs. Bibliographies of relevant articles were also r eviewed, Only randomized controlled trials were included. Data were ex tracted manually from relevant publications and are presented descript ively because formal, quantitative methods were not applicable. Nine s tudies met our inclusion criteria, Of the seven studies examining case management's impact on health resource use, only two found a positive effect, Both successful programs targeted patients with specified dis ease conditions and care was supervised by a medical subspecialist. No ne of the programs targeting general disease conditions or supervised by generalists reported a positive effect. All six studies examining p atient-centered outcomes reported a positive impact. These effects wer e unrelated to the patient's conditions or the study personnel. Both s tudies examining clinical parameters found a positive impact, Only thr ee studies examined costs: all reported nonsignificant cost savings, W hile case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to dis ease condition and specialty training of study personnel. Patient-cent ered outcomes were often improved upon but at unknown cost, Further mu ltisite clinical trials are needed to define case management's role in our future health care system.