Intended for healthcare professionals


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

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:31
  1. Hugh Gravelle, professor of economics1,
  2. Mark Dusheiko, research fellow1,
  3. Rod Sheaff, professor of health services research2,
  4. Penny Sargent, research associate3,
  5. Ruth Boaden, professor of service operations management3,
  6. Susan Pickard, research fellow4,
  7. Stuart Parker, professor of health care for older people5,
  8. Martin Roland, director4
  1. 1National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO10 5DD
  2. 2University of Plymouth, Peninsula Allied Health Centre, College of St Mark and St John, Plymouth PL6 8BH
  3. 3Manchester Business School, University of Manchester, Manchester M15 6PB
  4. 4National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
  5. 5Sheffield Institute for Studies of Ageing, University of Sheffield, Barnsley Hospital NHS Foundation Trust, Barnsley S75 2EP
  1. Correspondence to: M Roland m.roland{at}
  • Accepted 24 October 2006


Objectives To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people.

Design Practice level before and after analysis of hospital admissions data with control group.

Setting Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission.

Main outcome measures Rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out).

Results The intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval −5.7% to 38.7%), emergency bed days (increase 19.0%, −5.3% to 43.2%), and mortality (increase 34.4%, −1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged ≥65 effects on the rates of emergency admission (increase 2.5%, −2.1% to 7.0%), emergency bed days (decrease −4.9%, −10.8% to 1.0%), and mortality (increase 5.5%, −3.5% to 14.5%) were also non-significant.

Conclusions Case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.


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  • Contributors: All authors contributed to the design and execution of the overall evaluation. HG and MD designed and carried out the quantitative analyses. All authors commented on the analysis and contributed to writing the paper. MR is guarantor.

  • Funding: Department of Health grant to the National Primary Care Research and Development Centre.

  • Competing interests: None declared.

  • Ethical approval: Thames Valley multi-centre ethics committee.

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