Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014
Finding ways to provide better and less expensive healthcare for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population.
We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, healthcare use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and healthcare use outcomes. For each outcome, the number of significant and positive results was tabulated.
Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting healthcare use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to healthcare use. For the disease management models, most improvements were related to clinical outcomes.
Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.
Overview of article
- Systematic review of 27 Medline articles from May 31, 2008 through June 10, 2014. Articles included if they: 1) Included people with multiple chronic conditions (behavioral or mental health); 2) Addressed 1 or more clinical outcomes (healthcare use and spending, patient satisfaction); and 3) Compared results from an intervention group with a comparison group or baseline measurements
- Authors concluded case and care management may be promising models of care for people with multiple chronic conditions or disabilities
- Areas for future research: 1) Consistent methods of assessment of models of care to better understand which models have greatest impact; 2) Comparative effectiveness of different models of care, overall and for common chronic disease clusters; 3) Inclusion of control group in non-RCT evaluations to isolate true impact of intervention
- Limitations of review: 1) Methodological flaws of studies included (e.g., suboptimal study design (no control group); 2) Small sample sizes; and 3) Inconsistency in how outcomes are defined