An investigation of the effectiveness and cost-effectiveness of the case management approach for older people with multiple chronic conditions within a community healthcare setting

Abstract

Background: Case management of older people with multiple chronic conditions was being implemented widely across the UK as a method of reducing unplanned hospitalisations.

Aim of the study: To determine if a nurse-led case management approach is effective and/or cost-effective in relation to usual care in a community setting. There was a requirement to study care-giving in relation to strain that may be experienced by care-givers as a consequence of the intervention.

Methods: Prospective non randomised comparison trial involving control group (n=295) and intervention group (n=295) who received a targeted case management service. Data was collected across a 12 month period.

Results
Effectiveness Clinically important effect of 10% decrease in mean log bed-days was found when the two groups were analysed. There was an overall reduction in length of hospital stay of 33% in comparison to a higher overall reduction of 59% for the intervention group. Differences were significant in lengths of stay between groups at 6 and 9 months after commencement of the intervention. Significant differences were found over time for EQ-5D and EQ-5D VAS for the intervention group. Participants in the intervention group reported a significant improvement
(significant at p<0.5 df 470.37 CI: -11.3 to-2.04) at the end point in their level of functionality as a result of the intervention.

Cost effectiveness: There were significant differences in costs across groups for each time- point. Combined with significant differences in QALYs the cost utility analysis confirmed that the case management service was 100% cost-effective at a willingness to pay of £20,000-£30, 000.

Impact on caregivers: The participants in the intervention group spent less time in hospital compared with the usual care group and this did not lead to an increase in the burden placed on their care-givers.

Conclusion: Targeted nurse-led chronic illness case management approaches are both effective and cost-effective.

Date of Award	Jun 2011
Original language	English
Supervisor	Vivien Coates (Supervisor) & Gary Adamson (Supervisor)