J. Sochalski, T. Jaarsma, H. M. Krumholz et al., "What Works in Chronic Care Management: The Case of Heart Failure," Health Affairs, Jan./Feb. 2009 28(1):179–89.
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A study that reexamined data from 10 clinical trials of care management programs for heart failure patients found that multidisciplinary teams and in-person communications led to fewer hospital readmissions and readmission days.
Private health plans and public payers have implemented chronic care management programs with the goals of improving quality and health outcomes and saving money. Results range from encouraging to disappointing, with little conclusive evidence on what works. To determine which programs are most effective for managing heart failure—the leading cause of hospitalization among the elderly—this study assembled some of the world's top heart failure experts to reexamine data from notable randomized trials.
Private and public insurers alike have embraced an array of chronic care management programs to enhance quality and cost-effectiveness for chronically ill populations. In seeking which programs work best for management of heart failure—a condition that accounts for roughly 10 percent of total Medicare spending on inpatient care—this study provides important evidence, but the authors recommend additional testing of team and communications methods.
The researchers pooled and re-analyzed data from 10 randomized clinical trials of heart failure care management programs, conducted from 1990 through 2004 and comprising 2,028 cases in the United States, Australia, the Netherlands, and the United Kingdom. Researchers focused on two measures—hospital readmission and readmission days—to discern how program delivery methods (team-based care vs. a single heart failure expert, and telephone vs. in-person communication) contribute to patient outcomes.