Review: hospital based case management

Background: Although inequality in access to health care for migrant patients is well described, less is known about inequalities originating within the health-care system regarding choice of diagnostic procedure, diagnostic delay, treatment options, secondary prevention and follow-up offered to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity of both their health needs and the skills needed to meet these. However, categorical care is generally considered to be stigmatizing and to decrease care quality. The evidence base for both arguments is unclear. The aim of this review was therefore to investigate the effectiveness of specialized hospital-based case management for ethnic minority patients. Methods: This review used a health technology assessment model, including a systematic search of literature in the PubMed, Embase, the Cochrane Library, Sociological Abstracts, the Cumulative Index to Nursing and Allied Health Literature databases and grey literature. Results: Of the 5328 studies found in the literature search, only one matched the criteria for inclusion. It described a specialized tuberculosis-focused hospital-based treatment programme supported by a cross-disciplinary team that increased treatment completion among ethnic minority patients. Despite using broad search criteria and searching a wide range of migrant health-related information networks and databases, no other hospital-based migrant health clinics were identified. The single relevant study indicated that benefits of a specialized hospital-based migrant management programme might include reducing inequality and improving clinical outcomes. No studies supporting the argument that specialized hospital care is stigmatizing or reduces quality of care were