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A Matched‐Cohort Study of Health Services Utilization and Financial Outcomes for a Heart Failure Disease‐Management Program in Elderly Patients
Author(s) -
Berg Gregory D.,
Wadhwa Sandeep,
Johnson Alan E.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52457.x
Subject(s) - medicine , emergency department , propensity score matching , heart failure , intervention (counseling) , emergency medicine , disease management , cohort , cohort study , heart disease , physical therapy , disease , nursing , parkinson's disease
Objectives: To investigate the utilization and financial outcomes of a telephonic nursing disease‐management program for elderly patients with heart failure. Design: A 1‐year concurrent matched‐cohort study employing propensity score matching. Setting: Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana. Participants: A total of 533 program participants aged 65 and older matched to nonparticipants. Intervention: Disease‐management heart failure program employing a structured, evidence‐based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services. Measurements: Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect. Results: The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30‐day readmissions, and 45% fewer SNF bed days. Claims costs were $1,792 per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31. Conclusion: The study demonstrates that a commercially delivered heart failure disease‐management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.