A matched-cohort study of health services utilization and financial outcomes for a heart failure disease-management program in elderly patients.

OBJECTIVES To investigate the utilization and financial outcomes of a telephonic nursing disease-management program for elderly patients with heart failure. DESIGN A 1-year concurrent matched-cohort study employing propensity score matching. SETTING Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana. PARTICIPANTS A total of 533 program participants aged 65 and older matched to nonparticipants. INTERVENTION Disease-management heart failure program employing a structured, evidence-based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services. MEASUREMENTS Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect. RESULTS The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30-day readmissions, and 45% fewer SNF bed days. Claims costs were 1,792 dollars per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31. CONCLUSION The study demonstrates that a commercially delivered heart failure disease-management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.