Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
J Card Fail. 2010 Nov;16(11):859-66. doi: 10.1016/j.cardfail.2010.05.028.
Prior studies suggest that disease management programs may be effective in improving clinical and economic outcomes in patients with heart failure. Whether these types of programs can lower health care cost and be adapted to the primary care setting is unknown. This study was designed to assess the impact of a home-based disease management program, the Alere DayLink HF Monitoring System (HFMS), on the clinical and economic outcomes of Medicare beneficiaries recently hospitalized for heart failure who received the care from a community-based primary care practitioner.
The Heart Failure Home Care trial was a multicenter, randomized, controlled trial of sophisticated, monitoring of heart failure patients with an interactive program versus standard heart failure care with enhanced patient education and follow-up (SC) in Medicare-eligible patients. The study endpoints included cardiovascular death or rehospitalization for heart failure, length of hospital stay, total patient cost, and cost to Medicare at 6 months of enrollment. A total of 315 patients age ≥ 65 years old were randomized: 160 to the HFMS and 155 to SC. There were no significant statistical differences between the groups in regards to 6-month cardiac mortality, rehospitalizations for heart failure, or length of hospital stay. Of those, 304 patients had their Medicare data available. The information from the Medicare claims data was used to determine the cost. Information from the trial was used to determine costs of out-patient drugs and the interventions. The 6-month mean Medicare costs were estimated to be $17,837 and $13,886 for the HFMS and the SC groups, respectively. We found that overall medical costs of medicare patients were significantly higher for patients who were randomized to the HFMS arm than they were for the patients randomized to the SC arm.
Our study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program and less costly in patients who are elderly and receive the care from a community-based primary care practitioner.
先前的研究表明，疾病管理计划可能有助于改善心力衰竭患者的临床和经济结果。尚不清楚这些类型的计划是否可以降低医疗保健成本并适用于初级保健环境。本研究旨在评估基于家庭的疾病管理计划（Alere DayLink HF 监测系统（HFMS））对最近因心力衰竭住院并接受社区初级保健医生护理的医疗保险受益人的临床和经济结果的影响。
心力衰竭家庭护理试验是一项多中心、随机、对照试验，对接受过强化心力衰竭患者教育和随访（SC）的具有互动程序的复杂心力衰竭患者进行监测，与标准心力衰竭护理进行比较，纳入了符合医疗保险条件的患者。研究终点包括心血管死亡或心力衰竭再住院、住院时间、总患者费用和入组后 6 个月的医疗保险费用。共随机分配了 315 名年龄≥65 岁的患者：160 名患者接受 HFMS，155 名患者接受 SC。两组在 6 个月的心脏死亡率、心力衰竭再住院率或住院时间方面均无统计学差异。其中，304 名患者的医疗保险数据可用。从医疗保险索赔数据中获取信息以确定成本。从试验中获取信息以确定门诊药物和干预措施的成本。估计 HFMS 和 SC 组患者的 6 个月平均医疗保险费用分别为 17837 美元和 13886 美元。我们发现，与随机分配到 SC 组的患者相比，随机分配到 HFMS 组的患者的医疗保险患者的总体医疗费用明显更高。
我们的研究结果表明，强化患者教育和随访与具有互动程序的复杂家庭监测设备一样成功，并且在接受社区初级保健医生护理的老年患者中成本更低。
