Community-Based Health Education Programs Designed to Improve Clinical Measures Are Unlikely to Reduce Short-Term Costs or Utilization Without Additional Features Targeting These Outcomes

Abstract

Stakeholders often expect programs for persons with chronic conditions to “bend the cost curve.” This study assessed whether a diabetes self-management education (DSME) program offered as part of a multicomponent initiative could affect emergency department (ED) visits, hospital stays, and the associated costs for an underserved population in addition to the clinical indicators that DSME programs attempt to improve. The program was implemented in Camden, New Jersey, by the Camden Coalition of Healthcare Providers to address disparities in diabetes care. Data used are from medical records and from patient-level information about hospital services from Camden's hospitals. Using multivariate regression models to control for individual characteristics, changes in utilization over time and changes relative to 2 comparison groups were assessed. No reductions in ED visits, inpatient stays, or costs for participants were found over time or relative to the comparison groups. High utilization rates and costs for diabetes are associated with longer term disease progression and its sequelae; thus, DSME or peer support may not affect these in the near term. Some clinical indicators improved among participants, and these might lead to fewer costly adverse health events in the future. DSME deployed at the community level, without explicit segmentation and targeting of high health care utilizers or without components designed to affect costs and utilization, should not be expected to reduce short-term medical needs for participating individuals or care-seeking behaviors such that utilization is reduced. Stakeholders must include financial outcomes in a program's design if those outcomes are to improve.

Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost (Preprint)

“…[24] Finally, a study by Burton, et al, found improvements in clinical measures but no impact on healthcare utilization or cost. [25] None of these studies are directly analogous to the current study. The first two studies involved financial incentives which were lacking in the current study while the final study used an eight session educational program with many possible educational add-ons for a much underserved population.…”

“…This potential to create a different result was reflected in Burton, et al's, work in an underserved population. [25] Further study in patient groups with different demographic and economic characteristics would be beneficial.…”

Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study

“…One group-based peer-support intervention trial in Ireland found that a group-based peer-support intervention led to a €637.43 of lifetime saving in health payment [22]. Another study [6] reported that non-healthcare costs were reduced during the 3 years after implementation of the peer-support intervention, but these findings were not derived from an RCT [6]. The present study is the first study to show payment reductions/ savings of £350.76 of (£306.71 for inpatient and £44.05 for outpatient) at 3.25 years after the intervention had been completed.…”

“…Peer support is a low-cost intervention, and has been suggested to reduce healthcare costs [4], including among people with Type 2 diabetes [5,6]. Peer support can be provided through individual or group approaches and either face-to-face, telephone or online contact.…”

“…Peer support can be provided through individual or group approaches and either face-to-face, telephone or online contact. Peer support is a low-cost intervention, and has been suggested to reduce healthcare costs [4], including among people with Type 2 diabetes [5,6]. Analyses in studies on such interventions, however, either were only based on participants over the study period, without consideration of healthcare utilization across the whole study population [5], or findings were not derived from a trial [6].…”