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Review: Intensive case management for severe mental illness reduces rehospitalisation when previous hospital use has been high

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T Burns

Correspondence to: T Burns, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; Tom.burns@psych.ox.ac.uk

QUESTION

Question:

What factors affect the efficacy of intensive case management in reducing rates of hospital re-admission for people with severe mental health illness?

Outcomes:

Time in hospital (mean days per month).

METHODS

Design:

Systematic review of randomised controlled trials (with meta-analysis and meta-regression).

Data sources:

MEDLINE, EMBASE, PsychINFO, and CINAHL from inception to January 2007.

Study selection and analysis:

Randomised controlled trials (RCTs) comparing intensive case management (allocated case manager with caseload of ⩽20 people) to standard care (community mental health team or outpatients) or low intensity management (caseload of >20 people), for community dwelling people with severe mental health illness (schizophrenia or other similar disorder, depression with psychosis, or bipolar disorder). Exclusions: trials with acute crisis team intervention or control condition involving hospital-based care. A random effects meta-regression was used to examine the relation between hospital stay and covariates. Covariates included: trial size, year of study, country of study, baseline hospital use, similarity of the intervention to assertive community treatment (assessed …

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