Effectiveness of case management for adult patients with chronic liver disease: a systematic review

Review Question/Objective The objective of this systematic review is to synthesise the best available evidence on the effectiveness of case management for adult patients with chronic liver disease. Inclusion Criteria Types of participants Chronic liver disease patients This review will consider adult patients aged over 16 years, with a clinical diagnosis of CLD at any stage, including hospital-based case management participants. CLD will be defined as those who had HCV-antibody or HBsAg positive for more than six months, elevated serum alanine aminotransferase (ALT) level, clinically compensated or decompensate liver cirrhosis, hepatocellular carcinoma (HCC) either confirmed by liver histology or typical image studies. The exclusion criteria will include the following: patients with a coexisting chronic debilitating illness such as end-stage renal disease, stroke, inflammatory bowel disease, epilepsy, mental illness and malignancies other than HCC. Types of Interventions This review will consider any studies with a focus on case management interventions predominantly aimed at improving care coordination and nursing care quality of CLD patients including health education and program, social support, and integration of primary care and specialist management and disease management. This review will focus on coordination of multidisciplinary care and the integration of this with patients’ needs. We anticipate that such studies will generally have used a validated QOL tool to evaluate the effect of the case management intervention on patients’ quality of life. Types of outcomes The outcomes will include, but are not limited to: 1. Quality of care, as measured by self-designed evaluation questionnaires, e.g. awareness of disease, and satisfaction of health education, and patients’ overall satisfaction 2. Quality of life, as measured with any validated QOL instrument, such as generic (SF-36) and disease-specific scales (Chronic Liver Disease Questionnaire) of HRQOL 3. Hospitalisation costs, e.g. patients’ hospital stay