Questrom School of Business and NBER, Boston University, Boston, Massachusetts.
Harvard University, Cambridge, Massachusetts.
Health Econ. 2019 Feb;28(2):189-203. doi: 10.1002/hec.3836. Epub 2018 Oct 21.
Disease management programs aim to reduce cost by improving the quality of care for chronic diseases. Evidence of their effectiveness is mixed. Reducing health care spending sufficiently to cover program costs has proved particularly challenging. This study uses a difference in differences design to examine the impact of a diabetes disease management program for high risk patients on preventive tests, health outcomes, and cost of care. Heterogeneity is examined along the dimensions of severity (measured using the proxy of poor glycemic control) and preventive testing received in the baseline year. Although disease management programs tend to focus on the sickest, the impact of this program concentrates in the group of people who had not received recommended tests in the preintervention period. If confirmed, such findings are practically important to improve cost-effectiveness in disease management programs by targeting relevant subgroups defined both based on severity and on (missing) test information.
疾病管理计划旨在通过提高慢性病护理质量来降低成本。但它们的有效性证据参差不齐。要想降低医疗保健支出以足以覆盖项目成本，这被证明是极具挑战性的。本研究采用差异中的差异设计来考察高危患者糖尿病疾病管理计划对预防检测、健康结果和护理成本的影响。沿着严重程度（使用血糖控制不佳的代理指标衡量）和基线年接受的预防检测这两个维度来检查异质性。尽管疾病管理计划往往侧重于最病重的患者，但该计划的影响集中在那些在干预前没有接受推荐检测的人群中。如果得到证实，这些发现对于通过针对基于严重程度和（缺失）检测信息的相关亚组来提高疾病管理计划的成本效益具有重要的实际意义。
