Multidisciplinary teams, outreach or home care, and case management improve the quality of care in the terminally ill and the mentally illDo innovative models of health care delivery improve quality of care for selected vulnerable populations? A systematic review.
- Chambers, Dr Jacky
- Wadhwa, S
- Lavizzo-Mourey, R
BACKGROUND
Vulnerable populations are at higher risk of adverse health outcomes. Many people believe that traditional health-care delivery does not meet their needs. Innovative models of health-care delivery have emerged to better address these needs.
OBJECTIVE
To determine whether multidisciplinary teams, outreach or home care, and case management improve the quality of care in the terminally ill and the mentally ill.
METHOD
Systematic review.
LITERATURES SEARCH
English language articles were retrieved by searching MEDLINE and Genmed, 1977-1997. Reference lists were reviewed and contact was made with authors.
(1) Inclusion criteria: the study population fell into one of the two vulnerable population categories: relevant intervention; clinical outcomes; control group.
(2) Data extraction. Because of the heterogeneity of the populations, outcomes and study designs, meta-analysis was not performed. Twenty-four articles met all review criteria, 7 in the terminally ill and 17 in the mentally ill. The articles report on 17 trials.
MAIN OUTCOMES
Quality of life; quality of death; patient and caregiver satisfaction; hospitalization; functional, clinical and psychological outcomes.
MAIN RESULTS
Patient and caregiver satisfaction was consistently higher with innovative models of care. In no study was satisfaction lower. Functional, clinical, or psychological improvements were not consistently demonstrated across models or populations. For mentally ill patients, multidisciplinary outreach strategies were effective in reducing inpatient hospitalizations. Costs were inadequately assessed in the studies to draw a summary conclusion.
AUTHORS' CONCLUSIONS
More needs to be learned about the costs and health improvements of innovative models before we can determine whether the increased patient and caregiver satisfaction found justifies widespread use of these models. Development of a uniform set of quality outcome measures and encouragement to evaluate efforts and disseminate results will help accomplish this goal.