title: Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.
abstract: BACKGROUND
  To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years.
  
  
  METHODS
  The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups.
  
  
  RESULTS
  Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P < 0.0001), readmissions (-36.7%, P < 0.0001), and bed days (-17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia's risk equalization system for private insurers.
  
  
  CONCLUSIONS
  Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.
authors.affiliation: Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA. brent.hamar@healthways.com.
authors.forename: G Brent
authors.initials: GB
authors.lastname: Hamar
authors.affiliation: Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA. elizabeth.rula@healthways.com.
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Rula
authors.affiliation: Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA. carter.coberley@healthways.com.
authors.forename: Carter
authors.initials: C
authors.lastname: Coberley
authors.affiliation: Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA. jim.pope@healthways.com.
authors.forename: James E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: HCF, Level 6, 403 George Street, Sydney, NSW, 2000, Australia. slarkin@hcf.com.au.
authors.forename: Shaun
authors.initials: S
authors.lastname: Larkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D019468:Disease Management; D005260:Female; D006293:Health Promotion / Q000191:economics; D006331:Heart Diseases / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics* / Q000639:trends*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015397:Program Evaluation; D012044:Regression Analysis; D012189:Retrospective Studies; D012648:Self Care / Q000191:economics; D055815:Young Adult