Table 1 Study characteristics
From: Strategies for utilisation management of hospital services: a systematic review of interventions
Author (Year) Country | Design | Health care setting | Type of intervention | Control | Health Professionals involved in an intervention | Period, months | Number of Participants |
|---|---|---|---|---|---|---|---|
Sandberg et al. [66] (2015) Sweden | RCT | Community | Case management consisted of assessment, care coordination, providing general information, specific information and safety and monthly home visiting | Usual care | Nurse case managers, physiotherapists, physicians | 12 F/U | Control: 73 Exposed: 80 |
Haldiman et al. [40] (2014) the United States | Cross-sectional | Hospital | Prospective review of requests for fresh –frozen plasma and platelets using guidelines and pathologists as consultants | Before review | Blood bank staff, pathologist, ordering physician | 48 F/U | NR |
Goodnough et al. [37] (2014) the United States | NCBA | Hospital | Concurrent review using a real-time clinical decision support system (CDSS) consisted of interruptive best practice alerts (BPAs) at the time of physician order entry (POE) | CDSS | Physicians | 22 before and 30 F/U | NR |
Joo [46] (2014) the United States | longitudinal | Community | Case management comprises assessment, care plans, care services in homes, clinic settings or telephone consults, evaluation | No Case Management | Nurse case managers | Up to 24 F/U | Control: - Exposed: 252 |
Buckley et al. [24] (2013) the United States | NCBA | Medical institution | Drug-utilization management program using evidence-based guidelines and clinical pharmacists | Pre-Implementation of Drug-Utilization Review | Clinical pharmacists, physicians, nurses, hospital administrators | 6 before and 6 F/U | Control: 496 Exposed: 300 |
Reinius et al. [62] (2013) Sweden | RCT | Hospital | Case management using a personalised programme, telephone contact | Usual care | Nurses | 12 F/U | Control: 57 Exposed: 211 |
Crane et al. [30] (2012) the United States | CBA | Hospital | Case management comprises drop-in group visits, telehealth line and life skills training | Before Case Management | Family physician, nurse care manager, behavioural health professional | 12 before and 12 F/U | Control group: 36 Exposed: 340020 |
Roland et al. [64] (2012) the United Kingdom | Case-control | From hospital to community | Case management focused on integrated care, delivery system redesign, improved clinical information systems | No Case Management | Case managers, GPs, community nurses, social workers | 6 before 6 F/U | Control group: 17,311 Exposed: 3646 |
Koehler et al. [49] (2009) the United States | RCT | Hospital | Care coordination using supplemental care bundle consists of medication counselling, reconciliation by a clinical pharmacist, patient education, enhanced discharge planning, and phone follow-up | Usual care | Care coordinator, pharmacist | 2 F/U | Control: 21 Exposed: 20 |
Schraeder et al. [67] (2008) the United States | Quasi-experimental | Primary care | Case management emphasises collaboration between physicians, nurses and patients, risk identification, comprehensive assessment, collaborative planning, health monitoring, patient education and transitional care | Usual care | Nurse case managers, primary care physicians | 36 F/U | Control: 277 Exposed: 400 |
Holsinger et al. [42] (2008) the United States | NCBA | Hospitals | Collaborative model of learning, a “trial-and-learn” approach to quality improvement, including Plan-Do-Study-Act cycles to test and implement changes | Before model | Physicians, medical staff, representatives from quality improvement, utilisation review or case management, billing, compliance, and medical records departments | 19 before and 14 F/U | 54 hospitals- |
Sweeney et al. [77] (2007) the United States | Prospective cohort | HMO | Patient-centred management involves on-site assessment, education, home visits, frequent contact, and goal-oriented care plans | Usual case management | Care managers, team managers, nurses, physicians | 3 to 18 F/U | Control: 398 Exposed: 358 |
Phillips et al. [59] (2006) Australia | NCBA | ED | Case management includes psychosocial evaluation, access to health care practitioners | Before Case Management | Nurses, allied health professionals, social workers, psychiatrists, primary care provider | 12 before and 12 F/U | Control: 60 Exposed: 60 |
Sledge et al. [73] (2006) the United States | RCT | Primary care services | Case Management, including comprehensive medical and psychosocial assessment, care planning, follow-up, care coordination, self-management, counselling, telehealth line, home visiting | Usual care | Nurse case manager, social worker, psychiatrist, internist, primary care provider | 12 F/U | Control: 49 Exposed: 47 |
Mahendran et al. [54] (2006) Singapore | NCBA | From hospital to community | Case Management includes care planning, care coordination, continuity of care, patient education, referral, counselling, telephone contacts, home visiting, assessment, evaluation, and supportive therapy | No Case Management | Psychiatric nurses were recruited as psychiatric case managers | 12 F/U | Control: - Exposed: 227 |
Zemencuk et al. [85] (2006) the United States | CBA | Hospital | Physician profiling | No profiling | physicians | 12 before and 12 F/U | Control: 6 hospitals Exposed:1 hospital |
Latour et al. [52] (2006) the Netherlands | RCT | From hospital to community | Case management includes home visiting after discharge, assessment, set care plan consisting of psychosocial support, referral, and telephone follow up | Usual care | A nurse case manager, medical supervisor, general practitioner | 6 F/U | Control: 69 Exposed: 78 |
Hegney et al. [41] (2006) Australia | NCBA | Hospital | Discharge planning using a risk screening tool | Before intervention | Specialist community nurse | 9 before vs 9 F/U | Control: - Exposed: 2139 |
Horwitz et al. [43] (2005) the United States | RCT | Hospital | Case Management including referral to PCP, telephone or mail contacts, home visiting | Usual care | Case managers | 6 F/U | Control:109 Exposed: 121 Control:51 Exposed: 59 |
Leung et al. [53] (2004) China | RCT | Community | Case Management includes regular monitoring of subjects’ health status, telehealth line, home visiting, community-based supportive services | Usual service | A nurse case manager, case geriatricians | 12 F/U | Control: 47 Exposed: 45 |
Cox et al. [29] (2003) the United States | NCBA | Medical Center | Case management emphasises on the management of personal resources, medication compliance and therapeutic relationships | Before Case Management | Psychiatrists, nurses, psychologists, social worker | 12 to 84 F/U | Control: - Exposed: 185 |
Hwang et al. [44] (2002) Korea | Time series | Hospital | POE system | Pre- Physician’s order entry | Physicians | 3 before and 6 F/U | Control: 73 Exposed: 38 |
Fateha [34] (2002) Bahrain | Time series | Hospital | Concurrent Review | Before review | Medical staff | 96 F/U | – |
Ferrazzi et al. [35] (2001) Canada | NCBA | Community | Advanced life support drug treatment is given by ambulance attendants | Before the program | Ambulance attendants | 18 before vs 18 F/U | Control: 215 Exposed: 191 |
Okinet al [57]. (2000) the United States | NCBA | Hospital | Case Management includes services coordination, individual and group supportive therapy, housing arrangement, financial entitlements, referral to PCP, substance abuse referral, community services, home visiting | Before Case Management | Psychiatric social worker, case manager | 12 before and 12 F/U | Control: - Exposed: 53 |
Bates et al. [22] (1999) the United States | RCT | Hospital | Computerised physician order entry is given a reminder to the physician | No reminder | Physicians | 4 F/U | Control: 5886 Exposed: 5700 |
Wickizer et al. [82] (1998) the United States | Retrospective analysis | Hospital | Utilisation management strategies including: Pre-admission review, concurrent review | Before Utilisation management | Nurse reviewers, physician advisers | 60 | 49,654 |
Spillane et al. [74] (1997) United States | RCT | Hospital | Case management includes individualised care plans, psychosocial evaluation, care coordination | Usual care | ED physician, social worker, psychiatrist, ED nurse practitioner | 12 before and 12 F/U | Control: 25 Exposed: 27 |
Bree et al. [23] (1996) the United States | RCT | Hospital | Pre-certification includes mandatory radiology consultation; each radiology examination requires approval by the attending radiologist before it is performed | No Pre-certification | Attending radiology consultant, radiology clerical personnel | 12 F/U | Control: 1178 Exposed: 1022 |
Shea et al. [69] (1995) the United States | RCT | Hospital | Clinical information systems include: computer-generated informational messages directed to physicians | No message | Physicians | 23 F/U | Control: 6990 Exposed: 7109 |
Cardiff et al. [26] (1995) Canada | Time-series | Hospitals | Utilisation management strategy includes identifying patients who did not need to be in acute care beds, as defined by the ISD-A explicit criteria and modifying the level of care for such patients | Before Utilisation management program | Nurse reviewers, physicians | 12 before and 12 F/U | Control: Hospital C: 281 Hospital D: 312 Exposed: Hospital A: 600 Hospital B: 597 |
Styrborn [76] (1995) Sweden | Multicenter controlled trial | From hospital to community | Discharge Planning comprised: patient assessment, development of discharge plan, implementation in the form of provision of services, including patient/family education and service referrals, follow up/ evaluation | Ordinary discharge routines | Consultant geriatrician, nurse | 3 F/U | Control: Hospital B: 166 Hospital C: 190 Exposed: Hospital A: 180 |
Rosenberg et al. [65] (1995) the United States | Case-control | Hospital | Utilisation review, second opinion, discharge planning, case management | Sham review | Nurses, physicians | 8 F/U | Control: 3743 Exposed: 3702 |
Jambunathan et al. [45] (1995) the United States | Cross-sectional | Outpatient clinic | Case management including biopsychosocial assessment, care planning, care delivery, care coordination | Before Case Management | Nurses | 18 F/U | Control: -Exposed: 21 |
Williams et al. [83] (1994) Australia | Cross-sectional | Hospital | Drug utilisation review | No review | Drug use review panel | Patient admission to discharge | Control: - Exposed: 75 |
Wickizer [81] (1992) the United States | Retrospective analysis | Hospital | Utilisation Review consists of pre-admission authorisation and concurrent review | No Review | Registered nurses, physician advisors, medical personnel | 36 F/U | Control: - Exposed: 1844 |
Woodside et al. [84] (1991) the United States | Case-control | Hospital | Utilisation management strategies including concurrent review, consultation, discharge planning, care coordination | No Utilisation management | Care coordinator, physician, nurses | 3 F/U | Control: 191 Exposed: 73 |
Silver et al .[71] (1992) the United States | Cross-sectional | Hospital | Prospective review using guidelines | No review | Transfusion service technical personnel, physicians | 12 F/U | Control: -Exposed: 543 |
Fowkes et al. [36] (1986) the United Kingdom | Multicenter controlled trial | Hospitals | Appointment of a utilisation review committee, informational feedback given to physicians, the introduction of a new chest X-ray request form, concurrent review | No review | Physicians, clerical staff | 12 F/U | 44,632 |
Echols et al. [32] (1984) the United States | NCBA | Hospital | Drug utilisation Review using an antibiotic order form | Before the introduction of the order form | Physicians | 25 F/U | NR |
Restuccia [63] (1982) the United States | Multicenter controlled trial | Hospitals | Utilisation review consists of providing concurrent feedback to physicians | No feedback | Nurses review coordinators, physicians | 2 F/U | Control: hospital D: 51 Exposed: hospital A: 145 hospital B:68 hospital C: 60 |
Murphy [56] (2014) the United States | NCBA | Hospital | Case management includes multidisciplinary ED care coordination, individualised ED care guidelines, and information system | Before ED-care-coordination program | Physicians, nurses, mental health and substance abuse professionals, ED nurse managers, a pharmacist, a social worker, a chaplain | 12 before and 12 F/U | Control: 65 Exposed: 65 |
Chiang et al. [27] (2014) Taiwan | NCBA | Hospital | Case management using dynamic, internet-mediated, team-based support led by emergency physicians | Before Case Management | ED physicians, primary care physicians, psychiatrists, social workers, and pharmacologists | 6 before and 6 F/U | Control: - Exposed: 14 |
Pillow et al. [60] (2013) the United States | NCBA | Hospital | Care plans include social work assessment, directives to call pain team for the development of pain contract, radiologic studies, out-patient referral for speciality clinics, urinary toxicology studies, managed care referral, and psychiatric assessment | Before CP | Social workers, case managers, physicians | 6 before and 11 F/Uphil | Control: - Exposed: 50 |
Dehaven et al .[31] (2012) the United States | Quasi-experimental | From hospital to community | A community-based partnership includes improving access to a primary care provider through in-person or telephone access to the community health worker, referral | Usual care | Primary care providers, hospital-based coordinators, community health worker | 12 F/U | Control: 309 Exposed: 265 |
Tadros et al .[78] (2012) the United States | NCBA | EMS | Case management includes coordination of treatment and social services, in-person contact, EMS interface, referrals, phone calls, transports | Before Case Management | Primary care physicians, social workers, case managers and adult protective services personnel | 16 before and 15 F/U | Control: - Exposed: 51 |
Shah et al .[68] (2011) the United States | CBA | Primary care services | Care management includes access to medical and social resources, scheduling primary care appointments, following up on referrals, arranging for support services, e.g., housing, care transitions while in hospital, care navigation and care coordination between specialists and primary care providers | Before Case Management | Case managers, Primary care providers | 12 before and 3 to 12 F/U | Control: 160 Exposed: 98 |
Stokes-Buzzelli S et al. [75] (2010) the United States | NCBA | Hospital | Health Information Technologies consist of identifying the most frequently presenting patients and creating individualised care plans for those patients and access to care plans through electronic medical records | No HIT | ED attending, ED medical social worker, ED mental health social worker, ED psychologist, ED resident, ED clinical nurse specialists | Same pre-and post-intervention time for each patient but varied between patients from 3 to 23 | Control: - Exposed: 36 |
Grimmer-Somers et al. [38] (2010) Australia | NCBA | Community | Individualised care plan including health assessment, social support, problem-solving, empowerment, education, goal setting and mentoring | Before program | Social workers, nurses | 12 before and 12 F/U | Control: -Exposed: 37 |
Grover et al. [39] (2010) the United States | NCBA | Hospital | Case management using patient care plans consisted of referral to PCP, limiting narcotic use, pain management, chemical dependency behavioural health evaluation, social services | Before Case Management | Physicians, nurses, social service providers, pain management clinicians, specialists in behavioural health | 6 before and 6 F/U | Control: 96 Exposed: 96 |
Skinner et al. [72] (2009) the United Kingdom | CBA | Hospital | Case management includes evaluation, individualised care plan, referrals to other services, key contact, close observation | Before Case Management | ED consultant, ED specialist registrar, psychiatric nurse specialist, social workers, housing officers | 6 before vs 6 F/U | Control: 21 Exposed: 36 |
Shumway et al. [70] (2008) the United States | RCT | Hospital | Case management including individual assessment, crisis intervention, individual and group supportive therapy, arrangement of stable housing and financial entitlements, linkage to medical care providers, referral to substance abuse services, ongoing assertive community outreach | Usual care | Psychiatric social workers, nurse practitioners, primary care physicians, psychiatrist | 24 F/U | Control: 85 Exposed: 167 |
Pope et al. [61] (2000) Canada | NCBA | Hospital | Case management includes individualised care plan, limiting narcotics and benzodiazepines prescriptions and laboratory tests requested in ED, referral to PCP, pain program, addiction counselling, communicating care plans with other EDs, supportive therapy, arrangement of food services | Before Case management | Social workers, ED medical director, director of continuous quality improvement, patient care manager, psychiatric nurse, clinical nurse specialist, family physicians, community care providers | 12 before and 12 F/U | Control: 24 Exposed: 24 |
Moher et al. [55] (1992) Canada | RCT | Clinical teaching units | Discharge planning based on individual patient needs | Standard medical care | Nurse | 4 F/U | Control: 131 Exposed: 136 |
Kennedy et al. [47] (1987) the United States | RCT | Hospital | Discharge Planning is based on individual patient needs, emphasising communication with the patient and family | Care not described | Nurses | 1 F/U | Control: 41 Exposed: 39 |
Kurant et al. [51] (2018) the United States | Not stated | Hospital | Laboratory-based utilisation management programs, including electronic health record (EHR) laboratory orders database | Usual service | Not applicable | 8 months | 160,000 EHR laboratory orders |
Copeland et al. [28] (2017) the United States | NCBA | Hospital | Modelling of collective and individual oncologist per patient imaging counts | Before model | 12 months | 4605 patients | |
Pena et al. [58] (2014) the United States | NCBA | Hospital | Blood management program includes Improving communications and transfusion guidelines, Benchmarking using the issue-to-transfusion ratio and audits and gatekeeping of selected blood products | Before the Blood management program | The staff of the laboratory of the Blood Transfusion Service | 36 months | All of the transfused components at MGH from 2010 to 2012 |
Weilburg et al. [80] (2017) the United States | Retrospective cohort | Hospital | Analysis of high-cost imaging utilisation in a stable cohort of patients cared for by PCPs during a 7-year period | Statewide high-cost imaging use data from a major private payer on the basis of the same claim set | Primary care physicians & speciality care physicians | 84 months | 109,823 patients |
Konger et al .[50] (2016) the United States | NCBA | Hospital | Reductions in unnecessary clinical laboratory testing by using LES | pre-LES test volume | Pathologists | 36 months | 14,359 Exclusion Requests |
El-Othmani et al. [33] (2019) the United States | Retrospective analyse | Hospital | The Joint Utilization Management Program | Before the Joint Utilization Management Program | Physicians, post-acute care providers, and inpatient interdisciplinary teams | 12 before and 12 F/U | 683 JUMP patient |
Kim & Lee [48] (2020) Korea | Not stated | Medical Aid Beneficiaries | Case Management | Before Case Management | The case manager, a registered nurse or social worker, | 12 Months | 1741 case management clients |
Wasfy et al. [79] (2019) the United States | Ret rospective cohort | Hospital | Hospital Readmissions Reduction Program | Pre-law trends | Not applicable | 36 Months | 3,038,740 total index hospital stays |
Calsolaro et al. [25] (2019) Italy | Ret rospective analyse | Hospital | Potentially Preventable Readmission Grouping | Compering stand-alone admissions, index admissions and potentially preventable read missions | Geriatricians | 30 days | 1263 stand-alone admissions, 171 index admissions |