Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes

Abstract

BackgroundTo evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years.MethodsThe MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups.ResultsOver the 4 year period, program participation resulted in significant reductions in hospital admissions (−11.4%, P < 0.0001), readmissions (−36.7%, P < 0.0001), and bed days (−17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia’s risk equalization system for private insurers.ConclusionsResults confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…For this reason, many chronic disease prevention and management (CDPM) programs have been designed with the aim of improving outcomes in these patients. CDPM programs targeting diabetes, [3][4][5][6][7] asthma, 8,9 heart diseases, [10][11][12] depression, [13][14][15] chronic obstructive lung disease (COPD), 16,17 obesity, 18,19 kidney disease, 20 dyslipidemia, 21 hypertension 22 and chronic pain 23 have been shown to be effective in improving outcomes such as hospital admissions, costs, adherence to medication, disease control, use of health services, quality of life and mortality. However, these studies were conducted in different settings and were based on single diseases.…”

“…For this reason, many chronic disease prevention and management (CDPM) programs have been designed with the aim of improving outcomes in these patients. CDPM programs targeting diabetes, 3-7 asthma, 8,9 heart diseases, [10][11][12] costs, adherence to medication, disease control, use of health services, quality of life and mortality. However, these studies were conducted in different settings and were based on single diseases.…”

Examining the high users of hospital resources: implications of a profile developed from Australian health insurance claims data

“…26 There is a strong focus within the Australian health sector at present on reducing potentially preventable hospital admissions and moving care for chronic conditions outside of hospitals to the community. 27 Although the results of both insurer-and government-funded chronic disease management programs in Australia have been mixed, [28][29][30] the findings of the present study indicate that the heaviest users of hospital services are seeking services for a narrow range of conditions that are not the target of traditional disease management programs. hospitalisation -including chemotherapy, dialysis and most rehabilitation -in the top 1% of privately insured hospital users are not preventable.…”

How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA

“…Tools to measure patient empowerment have been developed [5], and there is evidence it is associated with more cost-effective use of health services [6], healthier behaviours [7], and improved quality of life and clinical outcomes [8]. Consequently, patient empowerment may help health systems cope with the growing burden of chronic disease [9].…”