Effect of case managers with a general medical patient population

The objectives of this study were to evaluate the effect of inpatient case management (CM) on a general medical service and to determine if a predicti on rule, identifying patients likely to need discharge planning services, c ould define a subset of patients for whom CM would be most effective. We hy pothesized that CM would have greatest impact on patients predicted to be a t highest risk of needing discharge planning to arrange for post-discharge medical services. We carried out a prospective controlled study. Six genera l medicine teams from a 600-bed urban teaching hospital were randomly assig ned to CM (n = 4) or standard care (SC) (n = 2). Number of patients = 302 ( 207 CM; 95 SC), Case managers participated in daily physician team rounds a nd coordinated discharge planning for CM patients; SC patients received dis charge planning from staff nurses or discharge planners when requested by p hysicians. The outcomes measured were deviation from the hospital length of stay (LOS) expected for a patient's diagnosis, patient satisfaction and no n-acute medical service utilization during the month after discharge. Overa ll, patients from CM and SC teams did not differ in their deviation from ex pected LOS, post-discharge medical service utilization and patient satisfac tion. However, after stratifying patients by their predicted need for post- discharge medical services, only patients in the 'high risk' category had a significantly shorter LOS under CM (2.9 days shorter than SC patients; P = 0.02). We concluded that, in this study, the effect of case managers on a general medical service was limited to shortening LOS only among a stratum of high risk patients.