The Effectiveness of Chronic Care Management for Heart Failure: Meta‐Regression Analyses to Explain the Heterogeneity in Outcomes

Abstract

Objective. To support decision making on how to best redesign chronic care by studying the heterogeneity in effectiveness across chronic care management evaluations for heart failure. Data Sources. Reviews and primary studies that evaluated chronic care management interventions. Study Design. A systematic review including meta-regression analyses to investigate three potential sources of heterogeneity in effectiveness: study quality, length of followup, and number of chronic care model components. Principal Findings. Our meta-analysis showed that chronic care management reduces mortality by a mean of 18 percent (95 percent CI: 0.72-0.94) and hospitalization by a mean of 18 percent (95 percent CI: 0.76-0.93) and improves quality of life by 7.14 points (95 percent CI: À9.55 to À4.72) on the Minnesota Living with Heart Failure questionnaire. We could not explain the considerable differences in hospitalization and quality of life across the studies. Conclusion. Chronic care management significantly reduces mortality. Positive effects on hospitalization and quality of life were shown, however, with substantial heterogeneity in effectiveness. This heterogeneity is not explained by study quality, length of follow-up, or the number of chronic care model components. More attention to the development and implementation of chronic care management is needed to support informed decision making on how to best redesign chronic care.

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

“…The usefulness and relevance of existing assessment instruments are limited as several of the quality assessment criteria are not applicable to studies on comprehensive care [89]. Also the Health Technology Assessment-Disease Management (HTA-DM) instrument [89] which was specifically developed to assess the quality of complex interventions such as comprehensive care has limitations and needs further validation [28,90]. We therefore decided to select six criteria from existing quality criteria lists [35,36] that in our opinion were most relevant for the assessment of studies on comprehensive care programs.…”

Supervivencia de pacientes con insuficiencia cardiaca en atención primaria

“…La supervivencia en pacientes con IC no solo se ha visto asociada con los tratamientos, sino que también tienen un importante peso atribuible en la supervivencia factores organizativos como la coordinación entre niveles, la planificación del seguimiento, la educación a los pacientes y su monitorización continua 31 . El objetivo del manejo de la IC debe ser reducir el riesgo de ingresos hospitalarios, lo que va a mejorar la calidad de vida y reducirá los costes de la atención a estos pacientes.…”

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management – Findings from the International BRIGHT Study

“…5 Chronic illness management (CIM), a care model which emphasizes continuity of care and promotes self-management support for patients, could therefore provide an opportunity to improve long-term outcomes post HTx given promising results in other chronic patient populations. 5,8,9 Studies in non-HTx populations have shown that CIM is associated with decreased healthcare utilization, 10,11 improvements in health-related behaviors, 12 increased quality-of-life, 11 and greater patient and caregiver satisfaction. 12 In transplantation, the reengineering of transplant follow-up care according to the principles of CIM has resulted in improved clinical outcomes, reduced health care utilization, and reduced costs.…”