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CAN A DISEASE SELF-MANAGEMENT PROGRAM REDUCE HEALTH CARE COSTS? THE CASE OF OLDER WOMEN WITH HEART DISEASE

Med Care 2003 Jun;41(6):706-15
Wheeler JR Department of Health management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA.

BACKGROUND: There is increasing interest in the potential for chronic disease self-management interventions to provide health benefits while reducing health care costs.

OBJECTIVES: To assess the impact of a heart disease management program on use of hospital services; to estimate associated hospital cost savings; and to compare potential cost savings with the cost of delivering the program.

RESEARCH DESIGN: Randomized, controlled study design. Data were collected from hospital billing records during a 36 month period. Multivariate models were used to compare health care use with cost between treatment and control groups. Estimated differences were then compared with the program costs to determine cost-effectiveness.

SUBJECTS: Participants were recruited from 6 hospital sites. Screening criteria included: female, 60 years or older, diagnosed cardiac disease, and seen by a physician approximately every 6 months. The study included 233 women in the intervention group and 219 in the control group. The "Women Take PRIDE" program utilizes a self-regulation process for addressing a problematic area of the heart regimen recommended by each woman's physician. It is tailored to the unique needs of older women.

MEASURES: Hospital admissions, in-patient days, emergency department visits.

RESULTS: Program participants experienced 46% fewer in-patient days (P <0.05) and 49% lower in-patient costs (P <0.10) than women in the control group. No significant differences in emergency department utilization were found. Hospital cost savings exceeded program costs by a ratio of nearly 5-to-1.

CONCLUSIONS: A heart disease self-management program can reduce health care utilization and potentially yield monetary benefits to a health plan.

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