Evaluating Disease Management Program Effectiveness: An Introduction to Survival Analysis

Linden, Ariel; Adams, John; Roberts, Nancy

doi:10.1089/dis.2004.7.180

Cited by 50 publications

(69 citation statements)

References 15 publications

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“…By taking time-to an event of interest into account, researchers are able to obtain additional information rather than just a binary yes–no for an intervention of interest. Time-to-event, or survival analyses models, therefore improve power and precision of a study by addressing censoring and attrition to include subjects who “survived” the program without experiencing the event (in this case, hospitalization), left the program prematurely, or were lost to follow-up [15]. …”

Section: Introductionmentioning

confidence: 99%

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Adepoju

Bolin

Phillips

et al. 2014

Patient Education and Counseling

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Objective This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization. Methods Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization. Results Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p = 0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm. Conclusion CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM. Practice implications Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients.

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Section: Introductionmentioning

confidence: 99%

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Adepoju

Bolin

Phillips

et al. 2014

Patient Education and Counseling

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“…As policy makers and Medicaid program directors look to care models that will meet the health care needs of vulnerable populations with chronic illness and simultaneously contain costs, it is important to remember that chronic condition management should include primary preventive services that reduce vulnerability to illness (e.g., flu shouts) and secondary preventive services that monitor for new health conditions (e.g., glucose tests). Disease management programs have demonstrated reductions in utilization associated with avoiding health crises, although caution must be used in evaluating the success of such programs 35,36 . Prevention services are similarly important with a population vulnerable to secondary morbidities.…”

Section: Discussionmentioning

confidence: 99%

Continuity in provider and site of care and preventive services receipt in an adult Medicaid population with physical disabilities

Allen

Wieland

Griffin³

et al. 2009

Disability and Health Journal

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Objective This study investigated the relationship between continuity of care (having one's own doctor and a regular site of care), and receipt of preventive services in a population of adult feefor-service Medicaid enrollees with physical disabilities. Methods A random sample of 555 physically disabled Rhode Island Medicaid enrollees aged 18-64 were surveyed by telephone. Respondents were asked about receipt of six preventive services in the previous year. They were also asked whether they had their own doctor and whether they had a regular site of care. Regression analyses with propensity score corrections for selection bias were used to test the associations between care continuity measures and the number of preventive services received, as well as the receipt of each individual service. Results After adjustment for predisposing, enabling and need factors, respondents with their own doctor received 0.73 more preventive services than peers without their own doctor, and respondents who had a usual site of care received 0.85 more services than peers who received care at the ED or who had no regular site. The influences of having a regular doctor and a usual site of care varied according to type of preventive service, and these influences appear to be largely complementary rather than overlapping. Conclusions Study findings suggest that care models for adults with physical disabilities should include mechanisms to ensure both physician and site continuity. A strong primary care component that links individual patients with a personal doctor, as well as care protocols that ensure receipt of preventive services appears to be optimal for medically needy populations.

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“…Each model has its strengths and weaknesses, and the choice of which evaluation technique to use will depend ultimately on factors such as available resources, data, and expertise. Other designs that are suitable and should be considered for evaluating these specific issues are time series analysis (Linden et al, 2003), survival analysis (Linden et al, 2004a), and instrumental variables (Linden & Adams, in press). …”

Section: Discussionmentioning

confidence: 99%

Evaluating the Effectiveness of Home Health as a Disease Management Strategy

Linden

2006

Home Health Care Management & Practice

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Home health (HH) is considered by many to be complementary to existing disease management (DM) programs, or even suitable as a stand-alone DM intervention. The advantage is thought to be with the face-to-face interaction, in contrast to the standard DM telephonic interview. However, much of the literature appears to indicate that telecommunication is as successful as face-toface contact (typically referred to as "usual care") for administering health surveys, providing counseling, changing health behaviors, and monitoring physiologic functioning. Given the desire to expand into the area of DM, HH agencies will need to identify and demonstrate areas in which they have a clinical and competitive edge over traditional DM models. This article describes and provides examples of three research designs that may assist the HH industry in evaluating their effectiveness in delivering DM services: the randomized controlled trial, the regression-discontinuity design, and casecontrol matching on the propensity score.H ome health (HH) is considered by many to be complementary to existing disease management (DM) programs, or even suitable as a stand-alone DM intervention. The prevailing thought is that HH holds an advantage over traditional DM telephonic interventions because of the face-to-face contact with patients. During the home visit, agents conduct a comprehensive assessment of the patient's living conditions and provide an objective appraisal of their functional status (physical and mental). In addition, HH caregivers identify and remove barriers and environmental irritants and ensure that patients correctly follow their treatment regimens. Taken at face value, it appears that these activities cannot be adequately replicated by a telephone call.To make a business case for HH as a suitable addition to existing DM interventions or as an alternative DM model altogether, it must first prove to be at least as effective in the delivery of DM interventions as well as being more cost-effective than standard DM methods. While telephonic and electronic communications can reach hundreds of individuals daily at relatively low cost, HH is subject to time and personnel constraints. The question is whether these fewer HH visits result in better results than their telephonic counterparts.The results gleaned from the health services research literature poses uncertainties about the advantages of face-to-face interactions over that of telecommunicating with patients.Several studies have demonstrated that there is no significant difference in how participants respond to health surveys when administered face-to-face versus telephonically

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Evaluating Disease Management Program Effectiveness: An Introduction to Survival Analysis

Cited by 50 publications

References 15 publications

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Continuity in provider and site of care and preventive services receipt in an adult Medicaid population with physical disabilities

Evaluating the Effectiveness of Home Health as a Disease Management Strategy

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