Examining End-of-Life Case Management: Systematic Review

Table 4

Systematic review results presented alphabetically by author.

Author/year/; country	Focus	Data Collection			Results
		Subjects	Data source	Methods
Aiken et al. (2006) [27], United States	To document outcomes of a demonstration program	240 patients “seriously chronically ill” (of whom 62 chronic obstructive lung disease and 130 congestive heart failure)		Randomized controlled trial Outcomes were assessed every 3 months by telephone discussion	Case managed patients had higher self-care management, lower symptom distress, greater vitality, and more legal preparation for death
Back et al. (2005) [29], United States	To examine resource use during the last 60 days of life; as compared between palliative care cases, managed persons were compared to and controls.	Seniors dying of cancer, October 1, 2001 to Oct 31, 2002 (82 in case managed intervention group, 183 controls)	CHIPS database and some electronic medical record data.	Quantitative analysis	Case managed seniors were less likely to die in hospital and less use of acute care hospital resources was also evident, as compared to seniors who did not receive case managed care
Browne and Braun [41] (2001), United States	Determine impact of case management, by assessing caregiver burden and care recipient effects after this program was discontinued	118 frail seniors (functionally frail in at least two activities of daily living and two instrumental activities of daily living, still living at home who had formerly received case managed home-based care; however, only 55 were able to be interviewed, and the others were too ill or impaired) and 106 family caregivers were interviewed	Interviews	Qualitative and quantitative data analysis	After the cessation of a case management program for home-based elderly persons, half of the responding caregivers reported deterioration in their own health and an increase in their emotional fatigue. The remaining seniors indicated that the program had been critical for their support and safety. The death rate was higher after program cessation
Elwyn et al. (2008) [42], US	To gain insight into the reasons for case managed reduction in hospital utilization	Reports by 5 case managers of care of 121 frail elders (assessed by practice teams as at high future risk of unplanned admission to hospital)	Embedded in a larger study	Qualitative analysis	The reduction in hospital use was correlated with an increased quality of life from the case managed care
Head and Cantrell (2009) [36], US	Illustrate the integration of case management within managed care	Single case study, palliative care team interventions	EOL managed care records	Case study of interventions	Case management ensured patient centered care, and this care was also cost effective
Head et al. (2010) [31], United States	To study a pilot project that integrated case management in a managed care program	35 palliative care patients (advanced heart, lung, liver, or neurological disease, HIV (AIDS), renal failure, or advanced cancer)	Integrated case management data	Quantitative, descriptive-comparative study.	There was a decrease in symptom distress one month after the onset of services, and with growing satisfaction with the case management services over the first 3-month period
Long and Marshall (1999) [37], United States	Compare health services use between dying persons who were receiving case management services and those not receiving it	34 patients (in last month of life) in case managed intervention group, 43 controls	Demographic information and health records	Quantitative data analysis.	Case managed clients were more likely to be admitted to hospital, to have longer hospital stays and to have more outpatient visits. Health care costs in the last month of life were 60% higher for the case managed group than the regular-care group. Case managers were mainly client advocates, with their clients receiving assistance in accessing needed health services
MacDonald et al. (1994) [43], United Kingdom	Assess the activities of nurse case managers, as well as the acceptability and perceived effectiveness of a new program of case management for terminally ill persons	199 cancer patients with predicted life expectancy of 1 year	Hospital and community-based healthcare workers, bereaved family members	Mail survey (healthcare workers) and interviews (bereaved family members)	Despite an expected visit after hospital discharge, only 62% were visited at home and 71% were telephoned at home. 21% were never visited at home or telephoned at home. 51% of contacts lasted 5 minutes or less; 59% of health care workers had not heard of the coordinating service, 87% thought it was beneficial, and 70% of comments about it were positive. Relatives reported issues, such as not getting ordered equipment; (46%) did not know how to get help (34%), had difficulty contacting a health care professional (7%), and (35%) found EOL care not well coordinated. Families of persons who did not get case managed care reported similar care issues
Meier et al. (2004) [38], United States	Determine the effectiveness of delivering palliative care through case management programs (in South Carolina)	321 patients (152 terminally ill persons in case managed intervention group), 169 controls (5 nurse case managers in intervention group, 4 in control group)	Clients followed until death or case closure	Outcomes (Edmonton Symptom Assessment Scale)	Early data revealed that palliative case managers were empowered to identify patient distress and given responsibility to take action on it and that this involved an improved working relationship with physicians. The model thus appeared feasible, as it also improved patient and family satisfaction
Naylor et al. (1999) [28], United States	Randomized control trial to examine the effectiveness of a nurse practitioner case management program lasting 4 weeks after hospital discharge	262 hospital patients 65+ years at risk of adverse outcomes, (124 in intervention group received postdischarge case management), 138 controls received “usual care”	Hospital services use, functional status, depression assessment, and patient satisfaction data	Quantitative data analysis.	Over the six-month study period, the intervention group patients were less likely to be readmitted to hospital (30% versus 37%) and had fewer days in hospital (270 versus 760) and a shorter average hospital stay (7.5 versus 11 days) and half the health care costs. No differences in functional status, depression, or patient satisfaction were found
Nickel et al. (1996) [39], United States	Randomized controlled trial study to assess the effectiveness of nurse case management for quality of life among AIDS clients living at home	57 patients with AIDS referred for home care (29 intervention, 28 control)	Quality of wellbeing Scale	Quantitative data analysis.	Quality of wellbeing scores declined rapidly for both groups, reflecting both a decline in quality of life and impending or actual death. The usual care group mean scores were lower than the intervention group scores. Half were deceased at 6 months. Wellbeing differences between the groups were not statistically significant
Pfeifer et al. (2006) [40], United States	Describe the evolution of a palliative care management pilot program	56 palliative care recipients with advanced cancer	Descriptive summary		Patient responses were mostly extremely positive. Many relied on the care manager for advice and direction, but they were always encouraged to be self-managers in following medical orders and being compliant with treatment protocols
Seow et al. (2008) [30], United States	Evaluate a cancer case management pilot program focusing on palliative care	89 palliative care patients with cancer (69 in intervention group, 20 in control)		Quantitative, statistical comparison	75% of eligible patients enrolled in the case management program, and 59% of these had no hospital admissions compared to 15% of patients in the comparison group
Spencer and Battye (2001) [34], England	Identify needed initiatives in home palliative care for children with advanced cancer	Children with advanced cancer; assessment of work of 35 health care professionals	Individual interviews and group discussions	Qualitative data analysis.	Many different approaches to case management were evident, as multiagency collaboration and service delivery were needed. Needed improvements were identified as better communication and liaison between all professionals involved, clearer roles (especially with regard to who was the case manager or case team), 24-hour specialist support, faster access to some services, and continuity of nursing and respite care. Community nurses were supposed to provide home support, with specialist nurses providing advice and support when needed
Spettell et al. (2009), [32] United States	To evaluate the impact of case management on the use of hospice and acute health care services	Intervention group: 3,491 enrollees in US health plan with usual hospice benefits, 387 with expanded hospice benefits, and 447 Medicare Advantage members with hospice benefits; control group: matched on age, severity of illness, and diagnosis, but died before specialized hospice care became available	Retrospective cohort design, three intervention groups each matched to a historical control group		Hospice use increased for all groups who received case management, as compared to the respective control groups: 30.8% versus 71.7% or 27.9% versus 69.8%
Twyman and Libbus (1994) [33], United States	Assess impact of case management on the number of days in hospital over the last 6 months of life as compared to days for persons who did not receive case management	100 individuals who died of AIDS 1989–92 in case managed intervention group; 99 controls	Retrospective medical and hospital records	Quantitative data analysis.	No significant difference in inpatient days was found (13.7 days for the case managed individuals versus 15.3 days for controls). Although there was not a major difference in hospital use, this may have been because the case managers acted as advocates for their clients, with increased hospital use, an outcome of this advocacy.
Williams (1999) [35], Canada	Identify deficiencies in palliative home care and remedies	Interviews with 3 case managers in Niagara region about their work and gaps in care	Grounded theory interviews	Qualitative data analysis	A wide range of service gaps were identified, including community services for informal caregivers, specialist palliative care providers, and with an inequity in home care services and quality of services across the region. Lack of timely services and minimal notification of new clients were also issues. Numerous strategies were identified. More community services include home care, more internal communications, and networking.