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Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes

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, beha...

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Autores principales: Hamar, G Brent, Rula, Elizabeth Y, Coberley, Carter, Pope, James E, Larkin, Shaun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422132/
https://www.ncbi.nlm.nih.gov/pubmed/25895499
http://dx.doi.org/10.1186/s12913-015-0834-z
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author Hamar, G Brent
Rula, Elizabeth Y
Coberley, Carter
Pope, James E
Larkin, Shaun
author_facet Hamar, G Brent
Rula, Elizabeth Y
Coberley, Carter
Pope, James E
Larkin, Shaun
author_sort Hamar, G Brent
collection PubMed
description 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.
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spelling pubmed-44221322015-05-07 Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes Hamar, G Brent Rula, Elizabeth Y Coberley, Carter Pope, James E Larkin, Shaun BMC Health Serv Res Research Article 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. BioMed Central 2015-04-22 /pmc/articles/PMC4422132/ /pubmed/25895499 http://dx.doi.org/10.1186/s12913-015-0834-z Text en © Hamar et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hamar, G Brent
Rula, Elizabeth Y
Coberley, Carter
Pope, James E
Larkin, Shaun
Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title_full Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title_fullStr Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title_full_unstemmed Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title_short Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes
title_sort long-term impact of a chronic disease management program on hospital utilization and cost in an australian population with heart disease or diabetes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422132/
https://www.ncbi.nlm.nih.gov/pubmed/25895499
http://dx.doi.org/10.1186/s12913-015-0834-z
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