A US study published in the May/June issue of Health Affairs reports on the first randomised trial providing a scientifically valid look at what one might expect from chronic disease management programmes that serve low-income individuals.
Researchers from the Indiana University School of Medicine, the Regenstrief Institute, and the School of Public and Environmental Affairs at Indiana University-Purdue University Indianapolis designed a study to determine whether chronic disease management of individuals with diabetes and/or congestive heart failure (CHF) improves health outcome and lowers healthcare costs.
In contrast to earlier studies, the researchers randomly assigned individuals with the two chronic conditions to either chronic disease management or a control group based on their primary care provider’s location. The researchers used a predictive model to identify individuals at risk for high levels of future healthcare utilisation.
Individuals judged to be at highest risk were given intensive healthcare management conducted by a nurse care manager. Those with lower risk were provided with education and care support over the phone. Their findings were much more complex than they had anticipated.
“The telephonic support, when given to the lower risk group for either disease, resulted in a significant reduction in subsequent healthcare claims paid,” said study senior author Thomas S Inui, MD, IU School of Medicine associate dean for healthcare research and Sam Regenstrief Professor of Health Services Research. Dr Inui also is president and CEO of the Regenstrief Institute.
Results for high-risk patients were more ambiguous. The researchers found that nurse care management resulted in lower average claims for high-risk CHF patients, but slightly higher average claims for high-risk diabetes patients, although neither effect was found to be statistically significant.