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A case manager intervention to reduce readmissions

J F Fitzgerald1, D M Smith, D K Martin

  • 1Department of Medicine, Indiana University School of Medicine, Indianapolis.

Archives of Internal Medicine
|August 8, 1994
PubMed
Summary
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Case management interventions involving frequent patient contacts did not reduce nonelective hospital readmissions. While patients in the intervention group attended more clinic visits, overall readmission rates remained unchanged, indicating limited effectiveness.

Area of Science:

  • Health Services Research
  • Medical Management
  • Patient Care

Background:

  • Acute hospitalizations incur significant costs, particularly for patients with repeated admissions.
  • Case management is a common strategy in managed care to control hospital use by addressing patient needs and improving care access.
  • Evidence on the efficacy of case management in reducing hospital readmissions is limited.

Purpose of the Study:

  • To evaluate the effectiveness of a case management intervention in reducing nonelective hospital readmissions.
  • To assess the impact of intensified postdischarge care and enhanced primary care access on hospital utilization.

Main Methods:

  • A randomized controlled trial was conducted at a Veterans Affairs medical center involving 668 patients aged 45+.

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  • Patients were randomized to an intervention group receiving case management or a control group.
  • The intervention included mailed materials, phone calls to address needs, and follow-up for missed appointments, with 6260 total contacts over 12 months.

    • Main Results:

    • Intervention patients showed a statistically significant increase in general medicine clinic visits per patient per month (0.30 vs. 0.26).
    • No significant differences were observed between the intervention and control groups in nonelective readmissions, readmission days, or total readmissions.

    Conclusions:

    • Intensified case management, characterized by frequent contacts for education, care coordination, and accessibility, did not effectively reduce nonelective hospital readmissions.
    • The study suggests that current case management protocols may not be sufficient to decrease readmission rates in this patient population.