Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid Program.
OBJECTIVE
To examine the impact of disease management on utilization of selected health care services.


METHODS
Prospective observational population-based study comparing Florida Medicaid patients who elected to participate in disease management (DM, N=15,275) with a usual-care (UC, N=32,034) group who elected not to participate in the program. Patients had at least one of four chronic diseases (diabetes, asthma, congestive heart failure, and hypertension) and all received standard health care. DM participants received supplementary telephone health counseling by a managed care specialist. The data for this paper were collected between October 2001 and October 2004.


RESULTS
Annual rates of inpatient hospital stays, inpatient days, emergency room (ER) visits, and outpatient (OP) visits, during and post intervention, were used as outcomes. Age, race, gender, comorbidities, severity indicators, geographic location and pre-intervention utilization were used as covariates. Compared to UC patients, DM patients had lower adjusted post intervention annualized rates of hospitalizations ranging from 0.07 to 0.38 stays, lower rates of hospital days ranging from 0.40 to 2.54 days, and lower rates of ER visits ranging from 0.10 to 0.91 visits per DM enrollee in all four chronic conditions. Most results were statistically significant at the 5% level, except for hypertension patients, where they were suggestive, though not significant.


CONCLUSIONS
Disease management is effective in reducing potentially avoidable inpatient hospital stays and ER visits among patients with chronic illness.
Afifi
Abdelmonem A
AA
School of Public Health, UCLA, Los Angeles, CA 90095-1772, USA. afifi@ucla.edu
Morisky
Donald E
DE
Kominski
Gerald F
GF
Kotlerman
Jenny B
JB
D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000517:prevention & control*; D003376:Counseling / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000517:prevention & control; D019468:Disease Management; D005260:Female; D005431:Florida; D006296:Health Services / Q000706:statistics & numerical data*; D006302:Health Services Research; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007223:Infant; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration; D008484:Medicaid / Q000458:organization & administration*; D008875:Middle Aged; D015397:Program Evaluation; D012044:Regression Analysis; D012189:Retrospective Studies