Effects of Care Management and Telehealth: A Longitudinal Analysis Using Medicare Data

Baker, Laurence C.; Macaulay, Dendy; Sorg, Rachael; Diener, Melissa; Johnson, Scott J.; Birnbaum, Howard G.

doi:10.1111/jgs.12407

Cited by 32 publications

(36 citation statements)

References 25 publications

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“…Several previous authors have argued for the importance of theory in designing telehealth interventions from a range of perspectives 255,280,285 and there are also existing frameworks for the assessment (rather than the design) of telehealth for chronic conditions, such as the model for assessment of telemedicine (MAST). 286 The intervention that is most relevant to our study and well described in terms of its underlying theoretical basis is the Comprehensive Health Enhancement Support System (CHESS), an umbrella term for several e-health programmes combining information, adherence strategies, decision-making tools and support services.…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…Baker et al 285 have highlighted the challenges of evaluating e-health because of the rapid state of change, but emphasise the need to focus on timeless universal principles and to develop models to elucidate treatment mechanisms. Kaplan 255 has argued that the evaluation of telehealth interventions requires methodological pluralism to understand the range of social and organisational factors that determine how telehealth is implemented, used and has effects.…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Relationship To Previous Studiesmentioning

confidence: 99%

Section: Relationship To Previous Studiesmentioning

confidence: 99%

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

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“…A later analysis of data on the same population (n = 1,767) focused on mortality, hospital admissions, and emergency department visits. 60 After 2 years, patients using the Health Buddy program had a 15% reduction in mortality risk and an 18% reduction in quarterly hospital admissions. The strongest effects were observed on admissions among COPD patients and on mortality among CHF patients and among those labeled as ''engaged.''…”

Section: The Observed Effects Of Chf Telemonitoringmentioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

309

210

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The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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“…33 In response to concerning vital signs, coordinators from CMH-CB's Health Buddy Program adjusted follow-up intervals, ultimately reducing mortality and hospitalizations. 51 By contrast, improvements were not seen in MCCD's Avera program, which distributed monitoring devices to 83% of its population. 51 These devices were absent from MAPCP proposals.…”

Section: Minimize Expenses By Sharing Resources and Avoiding Cost-inementioning

confidence: 99%

“…51 By contrast, improvements were not seen in MCCD's Avera program, which distributed monitoring devices to 83% of its population. 51 These devices were absent from MAPCP proposals.…”

Section: Minimize Expenses By Sharing Resources and Avoiding Cost-inementioning

confidence: 99%

Lessons for Primary Care from the First Ten Years of Medicare Coordinated Care Demonstration Projects

Liaw

Moore²,

Iko

et al. 2015

The Journal of the American Board of Family Medicine

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Over the past decade, Medicare has tested care coordination programs in an effort to achieve the triple aim of improving the patient experience, improving population health, and lowering costs. Although savings from this promising concept have not materialized, private payers are starting to offer blended payments to primary care. From these demonstrations, we propose 5 lessons for practices implementing care coordination: (1) minimize expenses by sharing resources and avoiding cost ineffective interventions; (2)

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Effects of Care Management and Telehealth: A Longitudinal Analysis Using Medicare Data

Abstract: Care management coupled with content-driven telehealth technology has potential to improve health outcomes in high-cost Medicare beneficiaries.

Cited by 32 publications

References 25 publications

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Lessons for Primary Care from the First Ten Years of Medicare Coordinated Care Demonstration Projects

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