B. L. Kass-Bartelmes (2002). "Preventing disability in the elderly with chronic disease." Research in Action(3): 1-8.

http://www.ahrq.gov/research/elderdis.htm

Research sponsored by the Agency for Healthcare Research and Quality led to development of a patient self-management program that can help prevent or delay disability even in patients with arthritis, heart disease, or hypertension. Patients are taught how to better manage their symptoms, adhere to medication regimens, and maintain functional ability. AHRQ-funded research shows that health education and lifestyle changes can reduce the negative consequences of chronic disease.

J. L. Roglieri, R. Futterman, et al. (1997). "Disease management interventions to improve outcomes in congestive heart failure." American Journal of Managed Care 3(12): 1831-39.

This study is part of a planned 24-month, multicenter, longitudinal comparison of a comprehensive congestive heart failure (CHF) disease management program and was designed to determine effectiveness after 12 months of implementation. The impact of interventions such as telemonitoring of patients, post-hospitalization follow-up, and provider education on selected primary outcomes (hospital admission and readmission rates, length of stay, total hospital days, and emergency room utilization) in a managed care setting was evaluated. Subjects in the study included all participants in the managed care plan, as well as 149 selected program participants. The effects of the program were analyzed for pure CHF and CHF-related diagnoses, with outcomes for the third quarter of 1996 (postintervention follow-up) being compared with those for the third quarter of 1995 (preintervention baseline). Overall, the data demonstrated significantly reduced admission and readmission rates for patients with the pure CHF diagnosis. Among the entire CHF patient population, the third quarter admission rate declined 63% (P = 0.00002), and the 30-day and 90-day readmission rates declined 75% (P = 0.02) and 74% (P = 0.004), respectively. Among program participants with pure CHF diagnoses, the 30-day readmission rate was reduced to 0, and an 83% reduction occurred for both the third quarter admission (P = 0.008) and 90-day readmission (P = 0.06) rates. In addition, the average length of stay for patients with CHF-related diagnoses was significantly reduced among both plan participants (P = 0.03) and program participants (P = 0.001). Reductions were also seen in total hospital days and emergency room utilization. These data thus indicate that a comprehensive disease management program can reduce healthcare utilization not only among CHF patients in the program but also among the entire managed care plan population.

A. Walker, S. Colagiuri, et al. (2002). Cost-benefit model of diabetes prevention and care, Australia. Model construction, assumptions and validation. Diabetes Simulation Modellers Conference, San Francisco.

http://www.natsem.canberra.edu.au/pubs/otherpubs/conf/cp_diabetes_22may02.pdf

This paper documents key features of the Cost-Benefit Model of Diabetes Prevention and Care, which was developed by the National Centre for Social and Economic Modelling (NATSEM), in collaboration with the Diabetes Centre at the Prince of Wales Hospital in Sydney.

The model can simulate both Type 1 and Type 2 diabetes. However, because the Type 1 and Type 2 diabetes submodels have identical structures, and because most people with diabetes suffer from Type 2 diabetes, the data sources described in this paper are for Type 2 only.

The model is of the dynamic group type and accounts for the incidence and progression of diabetes complications within the Australian population (as it is projected from 1995 to up to 2050). The model is designed to assess the cost impacts and health outcomes of a range of diabetes care and prevention interventions. Its aim is to facilitate the ranking of various proposed, past or ongoing interventions and thus help Australian decision makers in areas such as priority setting, or intervention program selection and evaluation.

This paper describes the structure of the Cost-Benefit Model of Diabetes Prevention and Care, lists the data sources used and assumptions embedded in the model and validates it through 'checks' of model outputs against data published by other organisations. The paper also discusses the sensitivity of model outputs to changes in certain key assumptions.