Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports.
OBJECTIVE
To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes.


METHODS
Meta-analysis.


METHODS
Computerised databases for English language articles during 1987-2001.


METHODS
102 articles evaluating 118 disease management programmes.


METHODS
Pooled effect sizes calculated with a random effects model.


RESULTS
Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (47/118) and provider feedback (32/118). Most programmes (70/118) used more than one intervention. Provider education, feedback, and reminders were associated with significant improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52 (0.35 to 0.69) respectively) and with significant improvements in patient disease control (effect sizes 0.35 (0.19 to 0.51), 0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patient education, reminders, and financial incentives were all associated with improvements in patient disease control (effect sizes 0.24 (0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54) respectively).


CONCLUSIONS
All studied interventions were associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.
Weingarten
Scott R
SR
Zynx Health, 9100 Wilshire Boulevard 665E, Beverly Hills, CA 90212, USA.
Henning
James M
JM
Badamgarav
Enkhe
E
Knight
Kevin
K
Hasselblad
Vic
V
Gano
Anacleto
A
Ofman
Joshua J
JJ
D002908:Chronic Disease / Q000628:therapy*; D002986:Clinical Trials as Topic; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic