Major Finding: Inpatient hospital admission among high-risk patients randomized to a telephone-based diabetes care management program for 1 year decreased significantly from 1.029 per member per year to 0.774 per member per year.
Data Source: A study of 526 members enrolled in a Medicare Advantage plan with Health Net of Arizona.
Disclosures: The study was funded by Alere, an Atlanta-based health management company. Dr. Rosenzweig is a member of the company's scientific advisory board.
SAN DIEGO — Elderly patients with type 2 diabetes and coronary artery disease who participated in a telephone-based disease management intervention had significant reductions in hospital inpatient admissions and total health care costs after 1 year, compared with those who did not receive the intervention.
“The results show that you can get short-term results by focusing on a few key indicators that include cardiac risk,” Dr. James L. Rosenzweig said during a press briefing.
The researchers conducted a prospective controlled repeated-measures study of 526 patients enrolled in a Medicare Advantage health plan with Health Net of Arizona who were identified as having diabetes and coronary artery disease. Of the 526 patients, 462 received the disease management program (intervention) and 64 received usual care (controls) for 1 year.
The goal of the intervention was to provide patients with access to nurse care managers via telephone so they could “address gaps of care with respect to both diabetes and its associated cardiovascular risk factors,” including blood pressure, lipids, and cholesterol management, said Dr. Rosenzweig, associate professor of medicine at Boston University, who carried out the study with Michael Taitel, Ph.D., vice president of the Alere Center for Health Intelligence, Atlanta.
“Diabetes education was delivered by the care managers in the course of their telephonic interactions with patients [and] there was close communication between the nurse care managers and the physicians' offices,” Dr. Rosenzweig explained.
“In addition, a subpopulation of these patients had home glucose monitoring data which they downloaded into the disease management system. This was uploaded to the care managers who would also evaluate the patients. They would send reports to [the patients'] physicians on a regular basis,” Dr. Rosenzweig added.
After 1 year, the number of all-cause inpatient hospital admissions among patients in the intervention group decreased from 1.029 per member per year to 0.774 per member per year, a difference that was statistically significant.
The slight decline among controls during the same time period—from 1.165 all-cause inpatient hospital admissions per member per year to 1.110—was not significant.
The number of diabetes-specific hospital admissions decreased from 0.717 per member per year to 0.445 among patients in the intervention group, but there were no significant differences among patients in the control group.
Dr. Rosenzweig also reported that annual medical costs dropped by about $1,000 for each patient in the intervention group but were nearly $5,000 higher for each patient in the control group, “suggesting that this kind of intervention could potentially involve savings of perhaps $6,000 per year per patient.”
Compared with patients in the control group, he added, those in the intervention group “reported having better monitoring of blood glucose levels. They also had more frequent cholesterol tests done by the physicians, more frequent eye examinations, more frequent screenings for kidney disease, hemoglobin A1c tests, and foot examinations.”
Dr. Rosenzweig said that he did not know what the administrative costs were to run the intervention component.
The study is expected to appear in the July 2010 issue of the American Journal of Managed Care.
'This kind of intervention could potentially involve savings of perhaps $6,000 per year per patient.'
Source DR. ROSENZWEIG