Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review
Objective Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriat...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e058539.full |
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| author | Eva Chang Rania Ali Nancy D Berkman |
| author_facet | Eva Chang Rania Ali Nancy D Berkman |
| author_sort | Eva Chang |
| collection | DOAJ |
| description | Objective Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriate use of healthcare services.Design A realist review which develops programme theories from causal explanations generated and articulated through the creation of context–mechanism–outcome configurations.Methods Electronic databases (including PubMed and Embase) and gray literature from January 2000 to March 2021 were searched. All study designs were included if the article provided data to develop our programme theories. Included studies were conducted in the USA and focused on interventions for adult, HNHC patients.Results Data were synthesised from 48 studies. Identifying HNHC patients for inclusion in interventions requires capturing a combination of characteristics including their prior use of healthcare services, complexity of chronic disease(s) profile, clinician judgment and willingness to participate. Once enrolled, engaging HNHC patients in interventions requires intervention care providers and patients to build a trusting relationship. Tailored, individualised assistance for medical and non-medical needs, emotional support and self-management education empowers patients to increase their participation in managing their own care. Engagement of care providers in interventions to expand support of HNHC patients is facilitated by targeted outreach, adequate staffing support with shared values and regular and open communication.Conclusions Building relationships with HNHC patients and gaining their trust is a key component for interventions to successfully change HNHC patients’ behaviors. Identifying HNHC patients for an intervention can be best achieved through a multipronged strategy that accounts for their clinical and psychosocial complexity and prior experiences with the healthcare system. Successful interventions recognise that relationships with HNHC patients require the sustained engagement of care providers. To succeed, providers need ongoing emotional, financial, logistical and practical resources.PROSPERO registration number CRD42020161179. |
| format | Article |
| id | doaj-art-6f333c27e164424ba3d228d8d8b3d5bd |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6f333c27e164424ba3d228d8d8b3d5bd2025-01-28T01:10:14ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-058539Unpacking complex interventions that manage care for high-need, high-cost patients: a realist reviewEva Chang0Rania Ali1Nancy D Berkman2RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USARTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USAsenior health policy research analystObjective Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriate use of healthcare services.Design A realist review which develops programme theories from causal explanations generated and articulated through the creation of context–mechanism–outcome configurations.Methods Electronic databases (including PubMed and Embase) and gray literature from January 2000 to March 2021 were searched. All study designs were included if the article provided data to develop our programme theories. Included studies were conducted in the USA and focused on interventions for adult, HNHC patients.Results Data were synthesised from 48 studies. Identifying HNHC patients for inclusion in interventions requires capturing a combination of characteristics including their prior use of healthcare services, complexity of chronic disease(s) profile, clinician judgment and willingness to participate. Once enrolled, engaging HNHC patients in interventions requires intervention care providers and patients to build a trusting relationship. Tailored, individualised assistance for medical and non-medical needs, emotional support and self-management education empowers patients to increase their participation in managing their own care. Engagement of care providers in interventions to expand support of HNHC patients is facilitated by targeted outreach, adequate staffing support with shared values and regular and open communication.Conclusions Building relationships with HNHC patients and gaining their trust is a key component for interventions to successfully change HNHC patients’ behaviors. Identifying HNHC patients for an intervention can be best achieved through a multipronged strategy that accounts for their clinical and psychosocial complexity and prior experiences with the healthcare system. Successful interventions recognise that relationships with HNHC patients require the sustained engagement of care providers. To succeed, providers need ongoing emotional, financial, logistical and practical resources.PROSPERO registration number CRD42020161179.https://bmjopen.bmj.com/content/12/6/e058539.full |
| spellingShingle | Eva Chang Rania Ali Nancy D Berkman Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review BMJ Open |
| title | Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review |
| title_full | Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review |
| title_fullStr | Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review |
| title_full_unstemmed | Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review |
| title_short | Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review |
| title_sort | unpacking complex interventions that manage care for high need high cost patients a realist review |
| url | https://bmjopen.bmj.com/content/12/6/e058539.full |
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