Impact of a Chronic Disease Management Program on Hospital Admissions and Readmissions in an Australian Population with Heart Disease or Diabetes

Abstract

Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary health care utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed. This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospital admissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart disease or diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment; n = 5053) to similar nonparticipating members (comparison; n = 23,077) using a difference-in-differences approach with the year before program commencement serving as baseline and the subsequent 12 or 18 months serving as the program periods. All outcomes were evaluated for the total study population and for diseasematched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regression controlling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months, treatment members displayed decreases in admissions (both, P £ 0.001) and readmissions (both, P £ 0.01), and ALOS after 18 months (P £ 0.01) versus the comparison group; magnitude of impact increased over time for these 3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, but the diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group, admissions decreased with increasing care calls to members (12 and 18 months, P < 0.0001). These results show that MHG successfully reduced the frequency and duration of hospital admissions and presents a promising approach to reduce the burden associated with hospitalizations in populations with chronic disease. (Population Health Management 2013;16:125-131)

Emergency readmissions are substantially determined by acute illness severity and chronic debilitating illness: A single centre cohort study

“…Our study does not determine the pathway through which total daily admissions mediate its effect on readmissions, the most likely hypothesis is that it reflects overstretching of physicians during the crucial early hours of an admission leading to an avoidable reduction in the quality of care provided. However, while chronic disease management programmes may be cost effective and reduce readmission rates, the load on the hospital with its capacity constraints would all require extra resources from the public purse in an era of austerity [32][33][34][35].…”

Seeking Out High Risk Population: The Prevalence Characteristics and Outcome of Diabetic Patients of Arab Ethnicity Hospitalized in Internal Medical and Acute Coronary Units in Israel

“…The reasons might be multifactorial, and it is important to note that interventions with chronic disease management programs for outpatients [13] and diabetes team consultation during hospitalization [10] have been proved to be an effective means to reduce the likelihood and duration of hospitalizations for individuals with diabetes. Implementing similar strategies in this high risk group and evaluating the impact of this intervention on outcomes of rate and recurrence of hospitalization and hospital length of stay is therefore of paramount importance.…”

“…These issues reflect the current practice and constraint on hospitalization length and on the performance of blood tests, pushing toward shorter hospital stay and cutting back on performing blood tests not directly relevant to the immediate hospital care. It will be of interest to examine whether interventions as described above [13] will cause changes in treatment regimens with improvement in long-term outcomes and readmissions. …”

Towards High Quality Health Care and Sustainable Financing – the Role of Health Care Programmes

“…A highly prevalent community based scheme is the Chronic Disease Self Management Programme (CDSMP), which aims to help participants gain confidence and skills to better manage their chronic conditions. It has now been implemented widely in many health care settings, with evidence of positive impact on health outcomes and downstream costs in both Shanghai, with the Shanghai Chronic Disease Self Management Programme and Australia, with the My Health Guardian Scheme (Brady, 2013;Dongbo et al, 2003;Hamar, 2013).…”