Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review.
OBJECTIVE
To assess the clinical and economic effects of disease management in patients with chronic diseases.


METHODS
Electronic databases were searched for English-language articles from 1987 to 2001. Articles were included if they used a systematic approach to care and evaluated patients with chronic disease, reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group.


RESULTS
Two reviewers evaluated 16,917 titles and identified 102 studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease, asthma, heart failure, back pain, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. Disease management programs for patients with depression had the highest percentage of comparisons (48% [41/86]) showing substantial improvements in patient care, whereas programs for patients with chronic obstructive pulmonary disease (9% [2/22]) or chronic pain (8% [1/12]) appeared to be the least effective. Of the outcomes more frequently studied, disease management appeared to improve patient satisfaction (71% [12/17]), patient adherence (47% [17/36]), and disease control (45% [33/74]) most commonly and cost-related outcomes least frequently (11% to 16%).


CONCLUSIONS
Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.
Cedars-Sinai Department of Medicine, Los Angeles, California, USA.
Joshua J
JJ
Ofman
Enkhe
E
Badamgarav
James M
JM
Henning
Kevin
K
Knight
Anacleto D
AD
Gano
Rebecka K
RK
Levan
Shoval
S
Gur-Arie
Margaret S
MS
Richards
Vic
V
Hasselblad
Scott R
SR
Weingarten
D002318:Cardiovascular Diseases / Q000191:economics; D002908:Chronic Disease / Q000191:economics*; D019468:Disease Management; D006801:Humans