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Strength of primary care orientation: ‘Case management’ may be replacing some of the functions of well-co-ordinated, person-centred primary care [12]. The effects of case management may therefore be greater when it is delivered in contexts where routine primary care services are less well developed. To test this hypothesis, we stratified results by the assessed orientation to primary care of the study country’s health system. The primary care orientation scores were developed by Starfield & Shi, and take into account—for each country—both characteristics of health system policy that are conducive to primary care, as well as characteristics of clinical practice [31]. |
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Multidisciplinary team versus single case manager: The hypothesis that teams are more effective than individuals at problem solving and delivering services is established across a number of diverse organisational settings [41], and teams have also been advocated in the treatment of patients with long-term conditions [42]. We tested whether case management by teams was more effective than by individuals. |
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Type of risk tool used: Targeting the ‘correct’ patients will be vital to any effective case management programme, particularly when assessed on cost and utilisation outcomes [43]. To test whether identification of the ‘correct’ patients was more effective when carried out by a rule-based model, we compared clinical judgement with rule-based and predictive models. |
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Inclusion of a social worker in case management: Collaboration between health and social services is thought to be important for effective case management [6], particularly of multimorbid patients who frequently have a complex mix of health and social care issues [44]. It also provides an additional, ‘professional’ level of care integration to the intervention [45], encouraging the different disciplines to work more closely together. To test the relative effectiveness of inclusion of a social worker, we therefore stratified results by this variable. |
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RCT versus non-RCT: RCTs are theoretically less vulnerable to bias, and therefore may give slightly different estimates of effect compared to observational studies (smaller/larger/reversed) [46]. We therefore compared RCTs to non-RCTs to observe any potential inconsistencies. |
