Do disease management programs for patients with coronary heart disease make a difference? Experiences of nine practices.
OBJECTIVE
To observe the experience of 9 practice sites in implementing provider-defined disease management programs for coronary heart disease patients.


METHODS
Observational study of provider-defined practice improvement programs.


METHODS
Practices chose from a variety of interventions that included provider- and patient-based disease management tools. Data were collected at baseline, 6, and 12 months.


RESULTS
Complete baseline, 6-month, and 12-month data were available for 586 patients (58% of the 1013 patients enrolled). Compared with baseline, 6-month data showed more patients whose total cholesterol was less than 200 mg/dL (56% to 76%; P < or = .001), whose low-density lipoprotein (LDL) cholesterol was less than 100 mg/dL (30% to 54%; P < or = .001), and whose high-density lipoprotein cholesterol was at least 35 mg/dL (75% to 81%; P < or = .001); who exercised rigorously for 30 minutes, 3 times a week (40% to 53%; P < or = .001); who used lipid medication (74% to 80%; P < or = .01); and who used aspirin (84% to 92%; P < or = .001). There were no significant improvements in triglyceride levels, blood pressure control, glycemic control among diabetes patients, smoking cessation, body mass index, and beta-blocker use. The 12-month results were similar to the 6-month results. Sites with a practice coordinator had the highest number of patients achieving their LDL goal (72% to 89%).


CONCLUSIONS
There may be an opportunity to improve patient care by applying disease management principles with a variety of interventions. Dedicated personnel to help coordinate disease management programs may be critical to the success of such programs.
Walsh
Mary N
MN
Northside Cardiology, Indianapolis, Ind., USA.
Simpson
Ross J
RJ
Wan
George J
GJ
Weiss
Thomas W
TW
Alexander
Charles M
CM
Markson
Leona E
LE
Berger
Marc L
ML
Pearson
Thomas A
TA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D015397:Program Evaluation; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014481:United States
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides