Case management does not reduce admissions or mortality

The Evercare case management system for older patients fails to reduce emergency admissions, emergency bed days or mortality, a BMJ study has revealed.

Laurence Buckman

The system, provided by UnitedHealth Europe was piloted in nine sites in England between 2003 and 2005, has since been rolled out across England as a one of the main elements of the community matron policy.

Case management aims to improve patient outcomes, and in particular to reduce unplanned hospital admission.
Deputy chairman of the BMA's GPs Committee Dr Laurence Buckman said: ‘Instead of fragmenting primary care services and introducing new models without proper evaluation, the government should devote more energy to supporting tried and tested general practice and resourcing existing hard-working community staff.’
The Evercare system uses advanced practice nurses to deliver a form of comprehensive geriatric assessment and draw up an individualised care plan that is agreed with the patient, GP and other staff. Patients are then monitored at a frequency best suited to their condition.

Researchers from National Primary Care and Development Centre evaluated the Evercare pilots and analysed the rates of emergency admission, emergency bed days and mortality in 62 Evercare practices.
The qualitative analysis suggested that case management added a frequency of contact, regular monitoring, psycho-social support and a range of referral options that had not previously been provided to frail, elderly people.

But the system had no significant impact on rates of emergency admission, bed days or mortality. The authors note that their results are consistent with the limited patient level evaluation published by UnitedHealth Europe.

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