BMJ  2007;334:109 (20 January), doi:10.1136/bmj.39094.396123.1F

Letters

Case management

Government should have respected evidence

Gravelle et al report the impact of case management (Evercare) on frail elderly patients.¹ The Evercare pilot study was based on the findings of one quasi-experimental study of case management in US nursing homes, albeit one with impressive results. It was imported to the United Kingdom in 10 pilot sites and applied to a very different group of patients (community dwelling), in a very different health economy, with different nursing skills and information system. Even the author of the original paper expressed surprise that the intervention had been implemented in this way.² This cost the UK taxpayer over £4m (6m; $7.8m)—not to mention the cost of "backfill" for community nursing posts vacated by the new advanced practitioner nurses. If the Department of Health had any regard for evidence it would not have ignored two excellent systematic reviews^{3 4} that showed no consistent evidence for the effectiveness of case management in preventing hospital attendances or admissions, reducing health costs, or improving function. Nor would they have repeatedly touted the "Castlefields" model⁵ (never published in a peer reviewed journal) as good evidence for chronic disease management. Most importantly, they would have commissioned a good randomised controlled trial of the intervention in the UK instead of commissioning an evaluation almost as an afterthought.

The only parties to emerge with credit from this exercise are the research team who did their best to perform a quasi experimental evaluation given the constraints of the project handed to them.

¹ Institute of Health Sciences, University of Reading, Reading RG1 5AQ d.oliver@reading.ac.uk

---

Competing interests: None declared.

References

1. Gravelle H, Dusheiko M, Sheaff S, Sargent P, Boaden R, Pickard S, et al. Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ 2007;334:31-4. (6 January.)[Abstract/Free Full Text]
2. Kane RL, Keckhafer G, Flood S, Bershadsky B, Siadatty MS. The effect of Evercare on hospital use. J Am Geriatr Soc 2003;51:1427-54.[CrossRef][ISI][Medline]
3. Singh D. Transforming chronic care. Evidence about people with long term conditions. University of Birmingham Health Services Management Centre. 2005. www.hsmc.bham.ac.uk/news/transformingchroniccare
4. Hutt R, Rosen R, McCauley J. Case-managing long term conditions. What impact does it have in the treatment of older people? London: King's Fund, 2004.
5. National Library for Health. Primary Care Information Service. Answer to question: "What is the best and most recent evidence for case management in primary care as a means of reducing admission rates to hospital?" 17 August 2005. www.clinicalanswers.nhs.uk/index.cfm?question=976

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data

Hugh Gravelle, Mark Dusheiko, Rod Sheaff, Penny Sargent, Ruth Boaden, Susan Pickard, Stuart Parker, and Martin Roland
BMJ 2007 334: 31. [Abstract] [Full Text] [PDF]