title: Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes.
abstract: Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary health care utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed. This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospital admissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart disease or diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment; n=5053) to similar nonparticipating members (comparison; n=23,077) using a difference-in-differences approach with the year before program commencement serving as baseline and the subsequent 12 or 18 months serving as the program periods. All outcomes were evaluated for the total study population and for disease-matched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regression controlling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months, treatment members displayed decreases in admissions (both, P≤0.001) and readmissions (both, P≤0.01), and ALOS after 18 months (P≤0.01) versus the comparison group; magnitude of impact increased over time for these 3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, but the diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group, admissions decreased with increasing care calls to members (12 and 18 months, P<0.0001). These results show that MHG successfully reduced the frequency and duration of hospital admissions and presents a promising approach to reduce the burden associated with hospitalizations in populations with chronic disease.
authors.affiliation: Center for Health Research, Healthways, Inc. , Franklin, Tennessee 37067, USA.
authors.forename: G Brent
authors.initials: GB
authors.lastname: Hamar
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Rula
authors.forename: Aaron
authors.initials: A
authors.lastname: Wells
authors.forename: Carter
authors.initials: C
authors.lastname: Coberley
authors.forename: James E
authors.initials: JE
authors.lastname: Pope
authors.forename: Shaun
authors.initials: S
authors.lastname: Larkin
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies