Does the impact of case management vary in different subgroups of multimorbidity? Secondary analysis of a quasi-experiment
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Published version
Author(s)
Stokes, J
Kristensen, SR
Checkland, K
Cheraghi-Sohi, S
Bower, P
Type
Journal Article
Abstract
Background: Health systems must transition from catering primarily to acute conditions, to meet the increasing burden of chronic disease and multimorbidity. Case management is a popular method of integrating care, seeking to accomplish this goal. However, the intervention has shown limited effectiveness. We explore whether the effects of case management vary in patients with different types of multimorbidity. Methods: We extended a previously published quasi-experiment (difference-in-differences analysis) with 2049 propensity matched case management intervention patients, adding an additional interaction term to determine subgroup effects (difference-in-difference-in-differences) by different conceptualisations of multimorbidity: 1) Mental-physical comorbidity versus others; 2) 3+ chronic conditions versus < 3; 3) Discordant versus concordant conditions; 4) Cardiovascular/metabolic cluster conditions only versus others; 5) Mental health-associated cluster conditions only versus others; 6) Musculoskeletal disorder cluster conditions only versus others 7) Charlson index > 5 versus others. Outcome measures included a variety of secondary care utilisation and cost measures. Results: The majority of conceptualisations suggested little to no difference in effect between subgroups. Where results were significant, the vast majority of effect sizes identified in either direction were very small. The trend across the majority of the results appeared to show very slight increases of admissions with treatment for the most complex patients (highest risk). The exceptions to this, patients with a Charlson index > 5 may benefit slightly more from case management with decreased ACSC admissions (effect size (ES): -0.06) and inpatient re-admissions (30 days, ES: -0.05), and patients with only cardiovascular/metabolic cluster conditions may benefit slightly more with decreased inpatient non-elective admissions (ES: -0.12). Only the three significant estimates for the musculoskeletal disorder cluster met the minimum requirement for at least a small effect. Two of these estimates in particular were very large. This cluster represented only 0.5% of the total patients analysed, however, so is hugely vulnerable to the effects of outliers, and makes us very cautious of interpreting these as real effects.
Date Issued
2017-08-03
Date Acceptance
2017-07-26
Citation
BMC Health Services Research, 2017, 17 (1)
ISSN
1472-6963
Publisher
BioMed Central
Journal / Book Title
BMC Health Services Research
Volume
17
Issue
1
Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
License URL
Subjects
1117 Public Health And Health Services
0807 Library And Information Studies
Health Policy & Services
Publication Status
Published
Article Number
521