Nurse-based telephone disease management trial showed little benefit

January 01, 0001

Nurse-based telephone disease management trial showed little benefit

In the US Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease- management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. The US authors randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries.

They found: "The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures."

The authors concluded: "In this large study, commercial disease- management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care."

This intervention was not based in or integrated with patients’ primary care services.

For the full abstract, click here.

N Engl J Med © 2011 to the Massachusetts Medical Society
Results of the Medicare Health Support Disease-Management Pilot Program. Nancy McCall, and Jerry Cromwell. Correspondence to Dr. McCall: nmccall@rti.org

Category: HSR. Health Services Research. Keywords: disease-management, Medicare, heart failure, diabetes, nurse, telephone, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 15 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.