Can a disease self-management program reduce health care costs? The case of older women with heart disease.
BACKGROUND
There is increasing interest in the potential for chronic disease self-management interventions to provide health benefits while reducing health care costs.


OBJECTIVE
To assess the impact of a heart disease management program on use of hospital services; to estimate associated hospital cost savings; and to compare potential cost savings with the cost of delivering the program.


METHODS
Randomized, controlled study design. Data were collected from hospital billing records during a 36 month period. Multivariate models were used to compare health care use with cost between treatment and control groups. Estimated differences were then compared with the program costs to determine cost-effectiveness.


METHODS
Participants were recruited from 6 hospital sites. Screening criteria included: female, 60 years or older, diagnosed cardiac disease, and seen by a physician approximately every 6 months. The study included 233 women in the intervention group and 219 in the control group. The "Women Take PRIDE" program utilizes a self-regulation process for addressing a problematic area of the heart regimen recommended by each woman's physician. It is tailored to the unique needs of older women.


METHODS
Hospital admissions, in-patient days, emergency department visits.


RESULTS
Program participants experienced 46% fewer in-patient days (P <0.05) and 49% lower in-patient costs (P <0.10) than women in the control group. No significant differences in emergency department utilization were found. Hospital cost savings exceeded program costs by a ratio of nearly 5-to-1.


CONCLUSIONS
A heart disease self-management program can reduce health care utilization and potentially yield monetary benefits to a health plan.
Wheeler
John R C
JR
Department of Health management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA. jackwhee@umich.edu
Janz
Nancy K
NK
Dodge
Julia A
JA
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006331:Heart Diseases / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D010353:Patient Education as Topic / Q000191:economics; D012648:Self Care / Q000191:economics*; D016387:Women's Health