Disease Management (health) - Studies of Effectiveness of Disease Management - Other Studies

Other Studies

Studies that have reviewed other studies on the effectiveness of disease management include the following:

• A 2004 Congressional Budget Office analysis concluded that published studies "do not provide a firm basis for concluding that disease management programs generally reduce total costs". The report caused the disease management industry to "scrambl to build a better business case for their services".
• A 2005 review of 44 studies on disease management found a positive return on investment (ROI) for congestive heart failure and multiple disease conditions, but inconclusive, mixed, or negative ROI for diabetes, asthma, and depression management programs. The lead author, of Cornell University and Thomson Medstat, was quoted as saying that the paucity of research conducted on the ROI of disease management was "a concern because so many companies and government agencies have adopted disease management to manage the cost of care for people with chronic conditions."
• A 2007 RAND summary of 26 reviews and meta-analyses of small-scale disease management programs, and 3 evaluations of population-based disease management programs, concluded that "Payers and policy makers should remain skeptical about vendor claims and should demand supporting evidence based on transparent and scientifically sound methods." In specific:
  • Disease management improved "clinical processes of care" (e.g., adherence to evidence-based guidelines) for congestive heart failure, coronary artery disease, diabetes, and depression.
  • There was inconclusive evidence, insufficient evidence, or evidence for no effect of disease management on health-related behaviors.
  • Disease management led to better disease control for congestive heart failure, coronary artery disease, diabetes, and depression.
  • There was inconclusive evidence, insufficient evidence, or evidence for no effect of disease management on clinical outcomes (e.g., "mortality and functional status").
  • Disease management reduced hospital admission rates for congestive heart failure, but increased health care utilization for depression, with inconclusive or insufficient evidence for the other diseases studied.
  • In the area of financial outcomes, there was inconclusive evidence, insufficient evidence, evidence for no effect, or evidence for increased costs.
  • Disease management increased patient satisfaction and health-related quality of life in congestive heart failure and depression, but the evidence was insufficient for the other diseases studied.

A subsequent letter to the editor claimed that disease management might nevertheless "satisfy buyers today, even if academics remain unconvinced".

• A 2008 systematic review and meta-analysis concluded that disease management for COPD "modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality".
• A 2009 review of 27 studies "could not draw definitive conclusions about the effectiveness or cost-effectiveness of... asthma disease-management programs" for adults.
• A Canadian systematic review published in 2009 found that home telehealth in chronic disease management may be cost-saving but that "the quality of the studies was generally low."
• Researchers from The Netherlands systematically reviewed 31 papers published 2007–2009 and determined that the evidence that disease management programs for four diseases reduce healthcare expenditures is "inconclusive."
• A meta-analysis of randomized trials published through 2009 estimated that disease management for diabetes has "a clinically moderate but significant impact on hemoglobin A_1C levels," with an absolute mean difference of 0.51% between experimental and control groups.
• A 2011 "meta-review" (systematic review of meta-analyses) of heart failure disease management programs found them to be of "mixed quality" in that they did not report important characteristics of the studies reviewed.

Recent studies not reviewed in the aforementioned papers include the following:

• A U.K. study published in 2007 found certain improvements in the care of patients with coronary artery disease and heart failure (e.g., better management of blood pressure and cholesterol) if they received nurse-led disease management instead of usual care.
• In a 2007 Canadian study, people were randomized to receive or not receive disease management for heart failure for a period of six months. Emergency room visits, hospital readmissions, and all-cause deaths were no different in the two groups after 2.8 years of follow-up.
• A 2008 U.S. study found that nurse-led disease management for patients with heart failure was "reasonably cost-effective" per quality-adjusted life year compared with a "usual care group".
• A 2008 study from the Netherlands compared no disease management with "basic" nurse-led disease management with "intensive" nurse-led disease management for patients discharged from the hospital with heart failure; it detected no significant differences in hospitalization and death for the three groups of patients.
• A retrospective cohort study from 2008 found that disease management did not increase the use of drugs recommended for patients after a heart attack.
• Of 15 care coordination (disease management) programs followed for two years in a 2008 study, "few programs improved patient behaviors, health, or quality of care" and "no program reduced gross or net expenditures".
• After 18 months, a 2008 Florida study found "virtually no overall impacts on hospital or emergency room (ER) use, Medicare expenditures, quality of care, or prescription drug use" for a disease management program.
• With minor exceptions, a paper published in 2008 did not find significant differences in outcomes among people with asthma randomly assigned to telephonic disease management, augmented disease management (including in-home respiratory therapist visits), or traditional care.
• A 2009 review by the Centers for Medicare and Medicaid Services of 35 disease management programs that were part of demonstration projects between 1999 and 2008 found that relatively few improved quality in a budget-neutral manner.
• In a 2009 randomized trial, high- and moderate-intensity disease management did not improve smoking cessation rates after 24 months compared with drug therapy alone.
• A randomized trial published in 2010 determined that disease management reduced a composite score of emergency room visits and hospitalizations among patients discharged from Veterans Administration hospitals for chronic obstructive pulmonary disease. A 2011 post-hoc analysis of the study's data estimated that the intervention produced a net cost savings of $593 per patient.
• A Spanish study published in 2011 randomized 52 people hospitalized for heart failure to follow-up with usual care, 52 to home visits, 52 to telephone follow-up, and 52 to an in-hospital heart failure unit. After a median of 10.8 months of follow-up, there were no significant differences in hospitalization or mortality among the four groups.
• Among 18–64 year old people with chronic diseases receiving Medicaid, telephone-based disease management in one group of members did not reduce ambulatory care visits, hospitalizations, or expenditures relative to a control group. Furthermore, in this 2011 study, the group receiving disease management had a lower decrease in emergency department visits than the group not receiving disease management.