Table 3.
Health measures
| Outcome | Type | Author, year | Findings | Evidence |
|---|---|---|---|---|
| Depression | M_A | Smith et al. (2016) | 5/7 studies showed improvements in a range of depression measures. 2/7 studies found no improvements in depression outcomes. A meta-analysis of Patient Health Questionnaire depression scores and a meta-analysis of standardized mean differences (MDs) in depression scores suggested a modest effect of the intervention. |
High consistency of evidence |
| SR_A | Low et al. (2011) | 2/3 studies found no difference in depression and psychological health, while 1/3 found an improvement. | ||
| SR_A | Hickam et al. (2013) | CM programs that serve patients with dementia reduce depression and strain among caregivers (strength of evidence: moderate). | ||
| SR_B | Eklund and Wilhelmson (2009) | Studies significantly in favor of intervention: 2/4. | ||
| Quality of life | SR_A | Hickam et al. (2013) | CM improves selected cancer-related symptoms and functioning (physical, psychosocial, and emotional), but not overall quality of life or survival (8 studies). CM programs that serve patients with CHF do improve CHF-related quality of life. | Mixed consistency of evidence |
| SR_A | Low et al. (2011) | 1/2 studies found a higher quality of life among CM patients, while 1/2 found no difference. | ||
| SR_B | Eklund and Wilhelmson (2009) | 1/3 studies were significantly in favor of the intervention. | ||
| SR_B | Joo and Liu (2017) | 1/2 studies found no difference in quality-of-life scores between the CM group and the control group after six months of CM implementation. 1/2 studies found significant positive effects on quality-of-life for the intervention group after two years of nurse-led CM intervention. | ||
| SR_B | Latour et al., 2007 | 3/4 studies (1 high-quality and 2 low-quality) found no difference in quality of life between the intervention and the control groups. Only one low-quality study reported a significant difference in favor of the intervention group. |
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| SR_C | Boult et al. (2009) | 7/8 studies found positive results in a set of quality-of-life measures (less decline in SF-36 social function; ↑ control of fatigue and mastery; ↑ SF-36, ↑ social support; ↑ SF-36; ↑ Minnesota Living with Heart Failure scores). | ||
| SR_C | Joo and Huber (2013) | Overall, community-based CM done by nurses enhanced patients’ quality of life | ||
| Clinical outcomes | M_A | Smith et al. (2016) | The MD in glycemic control between the intervention and control groups was 0.02 (95% CI − 0.21 to 0.25). The MD in blood pressure between the intervention and control groups was −3.10 (95% CI − 7.26 to 1.06). |
Low consistency of evidence |
| SR_A | Hickam et al. (2013) | 1/1 study found a moderate decrease in blood pressure, glucose and cholesterol levels after the CM intervention. | ||
| SR_A | Low et al. (2011) | One study reported a reduction in pain among CM patients and another showed an improvement in physical health. | ||
| Functional status | SR_A | Hickam et al. (2013) | CM programs that serve patients with one or more chronic diseases do not result in clinically important improvements in functional status (strength of evidence: high). | Low consistency of evidence |
| SR_A | Low et al. (2011) | 3/5 studies showed improvements in functional status ACTIVITIES OF DAILY LIVING/INSTRUMENTAL ACTIVITIES OF DAILY LIVING (ADL/IADL). 2/5 studies reported no difference in functional status (ADL/IADL). |
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| SR_B | Eklund and Wilhelmson (2009) | 4/6 studies reported no difference in functional status (ADL). 2/6 studies showed improvements in functional status (ADL). |
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| SR_B | Latour et al., 2007 | 2/2 studies (1 high-quality and 1 low-quality) found no significant difference in functional status between intervention and control groups. | ||
| SR_C | Boult et al. (2009) | Weak evidence of an improved functional autonomy (1/4 studies). | ||
| SR_C | Hallberg and Kristensson (2004) | 3/5 studies reported positive results in functional status measures (ADL, IADL). | ||
| SR_C | Hutt et al. (2004) | 3/6 RCTs showed statistically significant positive results for case-managed patients compared with other patients, in terms of either less decline in functional ability or an improvement in function. 1/6 RCTs found positive results, but they were not statistically significant. 2/6 RCTs revealed no differences between control and intervention groups. Non-RCTs: one before-and-after study showed a positive effect associated with CM. |
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| SR_C | Joo and Huber (2013) | 1/2 studies found an improvement in ADL and IADL for the CM group after one year of follow-up, while scores on these scales deteriorated in the control group. 1/2 studies showed no improvement in ADL and IADL. |
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| Survival | M_A | Stokes et al. (2015) | No significant effect on mortality (short-term: 0.08, 95% CI −0.03 to 0.19, I2 = 63.6%, P = 0.001, 12 studies; long-term: 0.03, 95% CI −0.04 to 0.09, I2 = 40.0%, P = 0.067, 13 studies). | High consistency of evidence of CM having no effect |
| SR_A | Hickam et al. (2013) | CM programs that serve patients with multiple chronic diseases do not reduce overall mortality (strength of evidence: high). CM does not affect mortality in frail elders (strength of evidence: low). |
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| SR_B | Eklund and Wilhelmson (2009) | 1/4 studies showed a reduction in the mortality risk. 3/4 studies reported no difference in the mortality risk. |
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| SR_C | Boult et al. (2009) | 4/8 studies reported positive results for mortality. | ||
| SR_C | Chiu and Newcomer (2007) | Most trials had comparable death rates among the intervention and control groups. | ||
| SR_C | Lupari et al. (2011) | One study reported no significant effect on mortality. | ||
| Patient satisfaction | M_A | Stokes et al. (2015) | Patient satisfaction showed a statistically significant improvement in the CM group in the short-term (0.26, 95% CI 0.16 to 0.36, I2 = 0.0%, P = 0.465, 8 studies), which increased in the long-term (0.35, 95% CI 0.04 to 0.66, I2 = 88.3%, P < 0.001, 4 studies). | High consistency of evidence of CM being effective |
| SR_A | Althaus et al. (2011) | 1/1 study reported no significant difference in patient satisfaction after the intervention. | ||
| SR_A | Hickam et al. (2013) | CM programs that serve patients with one or more chronic diseases increase patients’ perceptions that their care is better coordinated and of higher quality (strength of evidence: high). | ||
| SR_A | Low et al. (2011) | One study found no difference in satisfaction with care, while another reported a higher life satisfaction among CM patients. | ||
| SR_B | Eklund and Wilhelmson (2009) | 3/5 studies were significantly in favor of the intervention. | ||
| SR_B | Latour et al. (2007) | 2/3 studies (one high-quality and one low-quality) reported a positive effect of CM on patient satisfaction. 1/3 (high-quality) studies found no significant difference between the intervention and control groups. |
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| SR_B | Thomas et al. (2014) | 3 studies found a positive effect of CM programs on client satisfaction. | ||
| SR_C | Hallberg and Kristensson (2004) | 2/5 studies reported that the study group was more satisfied than the control group. 2/5 studies reported no effect on patient satisfaction. 1/5 studies reported a more satisfied control group. |
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| SR_C | Joo and Huber (2013) | Overall, community-based CM done by nurse case managers enhanced patients’ satisfaction. | ||
| SR_C | Lupari et al. (2011) | 4/4 studies reported high levels of satisfaction with nurses and their delivery of the CM intervention for complex patients. |
M_A = high-quality meta-analyses; SR_A = high-quality systematic reviews; SR_B = intermediate-quality systematic reviews; CHF = congestive heart failure; SR_C = low-quality systematic reviews; RCTs = randomized controlled trials.