DISEASE MANAGEMENT INTERVENTIONS TO IMPROVE OUTCOMES IN CONGESTIVE-HEART-FAILURE

This study is part of a planned 24-month, multicenter, longitudinal co mparison of a comprehensive congestive heart failure (CHF) disease man agement program and was designed to determine effectiveness after 12 m onths of implementation. The impact of interventions such as telemonit oring of patients, posthospitalization follow-up, and provider educati on on selected primary outcomes (hospital admission and readmission ra tes, length of stay, total hospital days, and emergency room utilizati on) in a managed care setting was evaluated. Subjects in the study inc luded all participants in the managed care plan, as well as 149 select ed program participants. The effects of the program were analyzed for pure CHF and CHF-related diagnoses, with outcomes for the third quarte r of 1996 (postintervention follow-up) being compared with those for t he third quarter of 1995 (preintervention baseline). Overall, the data demonstrated significantly reduced admission and readmission rates fo r patients with the pure CHF diagnosis. Among the entire CHF patient p opulation, the third-quarter admission rate declined 63% (P = 0.00002) , and the 30-day and 90-day readmission rates declined 75% (P = 0.02) and 74% (P = 0.004), respectively. Among program participants with pur e CHF diagnoses, the 30-day readmission rate was reduced to 0, and an 83% reduction occurred for both the third quarter admission (P = 0.008 ) and 90-day readmission (P = 0.06) rates. In addition, the average le ngth of stay for patients with CHF-related diagnoses was significantly reduced among both plan participants (P = 0.03) and program participa nts (P = 0.001). Reductions were also seen in total hospital days and emergency room utilization. These data thus indicate that a comprehens ive disease management program can reduce healthcare utilization not o nly among CHF patients in the program but also among the entire manage d care plan population.