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Meta-Analysis
. 2014 Oct 21;186(15):E568-78.
doi: 10.1503/cmaj.140289. Epub 2014 Sep 15.

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Andrea C Tricco  1 , Jesmin Antony  1 , Noah M Ivers  1 , Huda M Ashoor  1 , Paul A Khan  1 , Erik Blondal  1 , Marco Ghassemi  1 , Heather MacDonald  1 , Maggie H Chen  1 , Lianne Kark Ezer  1 , Sharon E Straus  2
Affiliations
Meta-Analysis

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis

Andrea C Tricco et al. CMAJ. .

Abstract

Background: Frequent users of health care services are a relatively small group of patients who account for a disproportionately large amount of health care utilization. We conducted a meta-analysis of the effectiveness of interventions to improve the coordination of care to reduce health care utilization in this patient group.

Methods: We searched MEDLINE, Embase and the Cochrane Library from inception until May 2014 for randomized clinical trials (RCTs) assessing quality improvement strategies for the coordination of care of frequent users of the health care system. Articles were screened, and data abstracted and appraised for quality by 2 reviewers, independently. Random effects meta-analyses were conducted.

Results: We identified 36 RCTs and 14 companion reports (total 7494 patients). Significantly fewer patients in the intervention group than in the control group were admitted to hospital (relative risk [RR] 0.81, 95% confidence interval [CI] 0.72-0.91). In subgroup analyses, a similar effect was observed among patients with chronic medical conditions other than mental illness, but not among patients with mental illness. In addition, significantly fewer patients 65 years and older in the intervention group than in the control group visited emergency departments (RR 0.69, 95% CI 0.54-0.89).

Interpretation: We found that quality improvement strategies for coordination of care reduced hospital admissions among patients with chronic conditions other than mental illness and reduced emergency department visits among older patients. Our results may help clinicians and policy-makers reduce utilization through the use of strategies that target the system (team changes, case management) and the patient (promotion of self-management).

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Figures

Figure 1:
Figure 1:
Selection of articles for the meta-analysis. RCT = randomized clinical trial.
Figure 2:
Figure 2:
Effect of quality improvement strategies for coordination of care on emergency department visits. Relative risks less than 1.0 indicate a decreased risk of an emergency department visit. CI = confidence interval, RR = relative risk.
Figure 3:
Figure 3:
Effect of quality improvement strategies for coordination of care on hospital admissions. Relative risks less than 1.0 indicate a decreased risk of admission to hospital. CI = confidence interval, RR = relative risk.
See this image and copyright information in PMC

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References

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