Center for Health Research, Healthways, Inc, Franklin, Tennessee 37067, USA.
Popul Health Manag. 2010 Dec;13(6):339-45. doi: 10.1089/pop.2010.0032. Epub 2010 Nov 23.
Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n = 17,319) and Comparison (n = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P < 0.001). The overall decrease in admissions for the Intervention group was driven by risk stratification levels 2 and 1, for which admissions decreased by 8.2% and 14.2% compared to Comparison group increases of 12.1% and 7.9%, respectively. Additionally, Intervention group admissions decreased as the number of calls increased (P = 0.004), indicating a dose-response relationship. These findings indicate that proactive chronic care management care calls can help reduce hospital admissions among German health insurance members with chronic disease.
住院治疗是医疗费用的主要来源，尽管通过合理管理慢性病，可以避免很大一部分住院治疗。在本研究中，我们评估了针对患有慢性病的德国某保险公司成员的主动慢性护理管理计划的影响。具体而言，我们测试了护士提供的护理电话对住院率的影响。研究参与者为同意参加慢性护理管理计划的冠心病、心力衰竭、糖尿病或慢性阻塞性肺疾病的参保个体。根据参与（或不参与）电话互动的记录，将干预组（n=17319）和对照组（n=5668）进行了区分。从项目开始前一年（基础年）和项目开始后一年计算入院率的变化。比较分析根据年龄、性别、居住地区和疾病严重程度（分为 3 级[最不严重]和 1 级[最严重]）进行了调整。总体而言，与对照组相比，干预组的入院率下降了 6.2%（P<0.001），而对照组的入院率则上升了 14.9%。干预组入院率总体下降是由风险分层 2 和 1 驱动的，与对照组的 12.1%和 7.9%相比，这两个分层的入院率分别下降了 8.2%和 14.2%。此外，随着电话次数的增加，干预组的入院人数也有所减少（P=0.004），表明存在剂量反应关系。这些发现表明，积极的慢性护理管理电话可以帮助减少德国医疗保险中患有慢性病的成员的住院人数。
