Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
Bupa Australia, Sydney, Australia.
J Gen Intern Med. 2019 Jan;34(1):41-48. doi: 10.1007/s11606-018-4682-5. Epub 2018 Sep 27.
Disease management programmes may improve quality of care, improve health outcomes and potentially reduce total healthcare costs. To date, only one very large population-based study has been undertaken and indicated reductions in hospital admissions > 10%.
We sought to confirm the effectiveness of population-based disease management programmes. The objective of this study was to evaluate the relative impact on healthcare utilisation and cost of participants the Costs to Australian Private Insurance - Coaching Health (CAPICHe) trial.
Parallel-group randomised controlled trial, intention-to-treat analysis SETTING: Australian population PARTICIPANTS: Forty-four thousand four hundred eighteen individuals (18-90 years of age) with private health insurance and diagnosis of heart failure, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, or low back pain, with predicted high cost claims for the following 12 months.
Health coaching for disease management from Bupa Health Dialog, vs Usual Care.
Total cost of claims per member to the private health insurer 1 year post-randomisation for hospital admissions, including same-day, medical and prostheses hospital claims, excluding any maternity costs. Analysis was based on the intent-to-treat population.
Estimated total cost 1 year post-randomisation was not significantly different (means: intervention group A$4934; 95% CI A$4823-A$5045 vs control group A$4868; 95% CI A$4680-A$5058; p = 0.524). However, the intervention group had significantly lower same-day admission costs (A$468; 95% CI A$454-A$482 vs A$508; 95% CI A$484-A$533; p = 0.002) and fewer same-day admissions per 1000 person-years (intervention group, 530; 95% CI 508-552 vs control group, 614; 95% CI 571-657; p = 0.002). Subgroup analyses indicated that the intervention group had significantly fewer admissions for patients with COPD and fewer same-day admissions for patients with diabetes.
Chronic disease health coaching was not effective to reduce the total cost after 12 months of follow-up for higher risk individuals with a chronic condition. Statistically significant changes were found with fewer same-day admissions; however, these did not translate into cost savings from a private health insurance perspective.
疾病管理计划可能会提高医疗质量，改善健康结果，并可能降低总体医疗成本。迄今为止，仅进行了一项非常大型的基于人群的研究，结果表明住院人数减少了>10%。
我们旨在证实基于人群的疾病管理计划的有效性。本研究的目的是评估参与澳大利亚私人保险费用-教练健康（CAPICHe）试验的患者的医疗利用和成本的相对影响。
平行组随机对照试验，意向治疗分析
澳大利亚人群
44118 名（18-90 岁）有私人医疗保险且患有心力衰竭、慢性阻塞性肺疾病（COPD）、冠状动脉疾病（CAD）、糖尿病或腰痛的个体，预计未来 12 个月内的索赔费用较高。
Bupa Health Dialog 的健康教练进行疾病管理，与常规护理进行对比。
随机分组后 1 年内每位成员向私人健康保险公司的索赔总成本，包括当日住院、医疗和假体住院索赔，但不包括任何产妇费用。分析基于意向治疗人群。
随机分组后 1 年的估计总成本无显著差异（均值：干预组 A$4934；95%CI A$4823-A$5045 与对照组 A$4868；95%CI A$4680-A$5058；p=0.524）。然而，干预组的当日入院费用显著较低（A$468；95%CI A$454-A$482 与 A$508；95%CI A$484-A$533；p=0.002），且每 1000 人年的当日入院人数也较少（干预组 530；95%CI 508-552 与对照组 614；95%CI 571-657；p=0.002）。亚组分析表明，干预组 COPD 患者的入院人数和糖尿病患者的当日入院人数均显著减少。
在随访 12 个月后，对于患有慢性病的高风险个体，慢性病健康教练并未有效降低总成本。虽然在统计学上发现当日入院人数减少，但从私人健康保险的角度来看，这并未转化为成本节约。
