Impact of the Implementation of Telemanagement on a Disease Management Program in an Elderly Heart Failure Cohort

Abstract

The purpose of the present investigation is to examine the impact of a telemanagement component on an outpatient disease management program in patients with heart failure (HF). A total of 282 patients in whom HF was diagnosed and who were enrolled in an outpatient HF program were included in this analysis. One hundred fifty-eight patients additionally participated in a self-directed telemanagement component. The remaining 124 patients received care at an HF clinic but declined telemanagement. During the 7-month tracking period, 19 patients in the HF clinic plus telemanagement group and 53 patients in the HF clinic only group were hospitalized for cardiac reasons (log rank, 36.0; P<.001). The HF clinic only group had a significantly higher risk for hospitalization (hazard ratio, 4.0; 95% confidence interval, 2.4-6.7; P<.001). The results of the present study indicate that telemanagement is an important component of a disease management program in patients with HF.

Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature

“…Cost estimates were adjusted for cross-country purchasing power differences (PPP), using 2007 US$ PPP [30] and for inflation, using GDP prices [30] in order to make meaningful comparisons across studies. Four studies did not report the year of data collection [31][32][33][34]. For these studies the year of publication of the papers was used as reference year.…”

“…Information provided was mostly limited to descriptions such as "conventional hospital-based care", "usual care", "standard care", "standardized usual care" or "usual care by physician". Eight studies reported usual care conditions in (more) detail [32][33][34][35][36][37][38][39] (Table 1). Table 1 presents the characteristics of the disease management programs included in our review.…”

Bridging the gap between evidence and practice in acute decompensated heart failure management

“…Numerous evaluations have established the effectiveness of these programs in enhancing use of appropriate medications, improving functional status, reducing readmissions and mortality, and decreasing costs. [44][45][46][47][48][49][50][51][52][53][54] For example, in separate evaluations, the prevalences of appropriate vasodilator use (93% vs. 61%; P < .001), 51 b-blocker use (71% vs. 40%; P < .001), 50 and ACE inhibitor use (84% vs. 59%; P < .001) 52 were significantly greater for disease management program participants compared with nonparticipants. In addition, participation in a disease management program was associated with a 52% reduction in the risk of hospitalization for cardiovascular causes (P < .001) and a 72% reduction in ED visits (P < .01) in 1 evaluation, 45 a 36% reduction (95% CI: 16.7%-50.9%) in the risk of heart failure admission or death in another, 53 and a 67% reduction (95% CI: 41%-82%) in the adjusted risk of death in yet another evaluation.…”

Strategies to Modify the Risk for Heart Failure Readmission: A Systematic Review and Meta-analysis

“…[8][9][10][11][12][13][14][15][16][17][18] In 9 of these studies, readmissions were significantly lowered. These interventions included:…”

“…Patient education during hospitalization and postdischarge telemonitoring for reinforcement of education and assessment of patients 13 or postdischarge home visits and monthly calls for reinforcement, assessment, and medication compliance 8 Phone calls after discharge for patient education, assessment of symptoms and compliance, and review of medication adherence 14 Postdischarge patient education at outpatient clinics and assessment of symptoms and compliance during clinic visits 12 or during follow-up calls every 2 to 4 weeks 16 Postdischarge assessments of medication adherence, symptoms/health, and compliance through a single home visit 1 week after discharge, 18 through daily telemonitoring and outpatient clinic visits every 1 to 2 weeks, 11 and through a daily telemonitoring system. 9 …”