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 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.