A Matched‐Cohort Study of Health Services Utilization and Financial Outcomes for a Heart Failure Disease‐Management Program in Elderly Patients

Publisher Website
Google Scholar
Abstract
Objectives: To investigate the utilization and financial outcomes of a telephonic nursing disease‐management program for elderly patients with heart failure.Design: A 1‐year concurrent matched‐cohort study employing propensity score matching.Setting: Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana.Participants: A total of 533 program participants aged 65 and older matched to nonparticipants.Intervention: Disease‐management heart failure program employing a structured, evidence‐based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services.Measurements: Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect.Results: The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30‐day readmissions, and 45% fewer SNF bed days. Claims costs were $1,792 per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31.Conclusion: The study demonstrates that a commercially delivered heart failure disease‐management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.