Community-based case management does not reduce hospital admissions for older people : a systematic review and meta-analysis

Objective: The aim of this study was to investigate the effectiveness of community-based case management in reducing hospital admissions for older people. Methods: Five databases were searched from inception to March 2018. Trials were included if: (1) participants were community-dwelling adults aged ≥65 years (2) intervention was community-based case management for ≥3 months (3) outcomes related to hospital admissions and (4) the design included a control group. The quality of evidence was independently assessed by two reviewers using the Physiotherapy Evidence Database (PEDro) scale and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were analysed descriptively and using meta-analyses where possible. Results: Nine trials (n = 5468 participants) were included in the analysis. Meta-analysis found community-based case management did not reduce hospital admissions (standard mean difference -0.09 95% confidence interval (CI) -0.27, 0.10), but did reduce emergency department (ED) presentations (mean difference -0.26 95% CI -0.51, -0.01). Conclusion: Community-based case management intervention may be effective in reducing ED presentations for older people. What is known about the topic?: Although community-based case management is common in Australia, little is known about its effectiveness in reducing healthcare utilisation for community-dwelling older people. What does this paper add?: The results indicate that community-based case management may decrease the number of ED presentations among older people. What are the implications for practitioners?: Patients with high ED presentation rates may benefit from community-based case management to reduce the number of unnecessary ED presentations.