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.