Chronic case management: Clinical governance with cost reductions.
BACKGROUND
With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care.


METHODS
We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP.


RESULTS
We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs.


CONCLUSIONS
Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.
Pontifícia Universidade Católica do Paraná, Pontifícia Universidade Católica do Paraná, Curitiba PR , Brazil, Medical Audit, Fundação Unimed. Cardiologist by Pontifícia Universidade Católica do Paraná (PUC-PR). Executive MBA in Health Administration by Instituto Superior de Administração e Economia/ Fundação Getulio Vargas (ISAE/FGV), Curitiba, PR, Brazil.
Élide Sbardellotto Mariano da
ÉS
Costa
Pontifícia Universidade Católica de São Paulo, PUC, Curitiba PR , Brazil, Occupational Health Coordinator, PUC-PR. Oncologist, Universidade Federal do Paraná (UFPR). Executive MBA in Health Administration by ISAE/FGV, Curitiba, PR, Brazil.
Adriano
A
Hyeda
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D019090:Case Management / Q000191:economics; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D054976:Clinical Governance / Q000191:economics*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics; D011446:Prospective Studies; D012737:Sex Factors; D055815:Young Adult