Excerpt

In 2010, the Agency for Healthcare Research and Quality (AHRQ) charged the Oregon Evidence-based Practice Center (EPC) with conducting a review to evaluate the comparative effectiveness of outpatient case management (CM) as an intervention strategy for chronic illness management. The aims of the review were to assess the evidence pertaining to the effectiveness of CM in improving patient-centered outcomes, quality of care, and resource utilization in adults with chronic medical illness and complex care needs. It also evaluated the effectiveness of CM based on patient and intervention characteristics.

After synthesizing the results from 109 studies, the original Comparative Effectiveness Review (CER) concluded that, while there were a number of approaches to CM matching the review's definition and scope, the interventions had limited impact on patient-centered outcomes, quality of care, and resource utilization among patients with chronic medical illness. Nevertheless, the review was able to identify some clinical settings in which CM had positive (though modest) effects on these outcomes.

The objective of this Future Research Needs (FRN) project was to engage a range of stakeholders and combine their insight with the results of the CER and a scan of the recent literature and studies in progress. Drawing from all these sources we sought to identify and prioritize topics for future research that could inform health care decisionmaking and policy regarding CM.

Contents

• Preface
• Acknowledgments
• Executive Summary
• Background
  • Evidence Gaps
  • Key Research Gaps
• Methods
  • Identification of Evidence Gaps
  • Engagement of Stakeholders
  • Identification of Recently Completed and Ongoing Studies
  • Research Question Development and Research Design Considerations
• Results
  • Recruitment and Participation
  • Identification of Research Gaps
  • Ranking by Stakeholders
  • Research Topic Domains and Potential Study Designs
  • Responses to Open-Ended Items
  • Literature Scan Results
  • Synthesis of Results: Foundation for a Future Research Agenda
• Discussion
• Conclusion
• References
• Acronyms and Abbreviations
• Appendix A Stakeholder Invitation
• Appendix B Online Questionnaire
• Appendix C Detailed Search Strategy for Recent and Ongoing Studies
• Appendix D Detailed Topic Rankings Ordered by Mean Score
• Appendix E Responses to Open-Ended Question: What Aspects of Case Management Should Be Measured and Reported?
• Appendix F Recently Completed Studies/Projects on the Effectiveness of Case Management
• Appendix G Ongoing Studies/Projects on the Effectiveness of Case Management

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10057-I. Prepared by: Oregon Evidence-based Practice Center, Portland, OR

Suggested citation:

Totten AM, Wagner J, Motu'apuaka M, Hickam DH, Guise JM. Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs. Future Research Needs Paper No. 30. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC035-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov