Disease management 360 degrees: a scorecard approach to evaluating TRICARE's programs for asthma, congestive heart failure, and diabetes.
OBJECTIVE
To assess the effect of TRICARE's asthma, congestive heart failure, and diabetes disease management programs using a scorecard approach. EVALUATION MEASURES: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard.


METHODS
Actual outcomes for program participants were compared with outcomes predicted in the absence of disease management. The predictive equations were established from regression models based on historical control groups (n = 39,217). Z scores were calculated for the humanistic measures obtained through a mailed survey.


METHODS
Administrative records containing medical claims, patient demographics and characteristics, and program participation status were linked using an encrypted patient identifier (n = 57,489). The study time frame is 1 year prior to program inception through 2 years afterward (October 2005-September 2008). A historical control group was identified with the baseline year starting October 2003 and a 1-year follow-up period starting October 2004. A survey was administered to a subset of participants 6 months after baseline assessment (39% response rate).


RESULTS
Within the observation window--24 months for asthma and congestive heart failure, and 15 months for the diabetes program--we observed modest reductions in hospital days and healthcare cost for all 3 programs and reductions in emergency visits for 2 programs. Most clinical outcomes moved in the direction anticipated.


CONCLUSIONS
The scorecard provided a useful tool to track performance of 3 regional contractors for each of 3 diseases and over time.
Yang
Wenya
W
The Lewin Group, Falls Church, VA 22042, USA. grace.yang@lewin.com
Dall
Timothy M
TM
Zhang
Yiduo
Y
Hogan
Paul F
PF
Arday
David R
DR
Gantt
Cynthia J
CJ
D000328:Adult; D001249:Asthma / Q000628:therapy*; D019985:Benchmarking / Q000379:methods*; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012044:Regression Analysis; D014481:United States