Can a disease self-management program reduce health care costs? The case of older women with heart disease

BACKGROUND. There is increasing interest in the potential for chronic disease self-management interventions to provide health benefits while reducing health care costs. OBJECTIVES. To assess the impact of a heart disease management program on use of hospital services; to estimate associated hospital cost savings; and to compare potential cost savings with the cost of delivering the program. RESEARCH DESIGN. Randomized, controlled study design. Data were collected from hospital billing records during a 36 month period. Multivariate models were used to compare health care use with cost between treatment and control groups. Estimated differences were then compared with the program costs to determine cost-effectiveness. SUBJECTS. Participants were recruited from 6 hospital sites. Screening criteria included: female, 60 years or older, diagnosed cardiac disease, and seen by a physician approximately every 6 months. The study included 233 women in the intervention group and 219 in the control group. The "Women Take PRIDE" program utilizes a self-regulation process for addressing a problematic area of the heart regimen recommended by each woman's physician. It is tailored to the unique needs of older women. MEASURES. Hospital admissions, in-patient days, emergency department visits. RESULTS. Program participants experienced 46% fewer in-patient days (P < 0.05) and 49% lower in-patient costs (P < 0.10) than women in the control group. No significant differences in emergency department utilization were found. Hospital cost savings exceeded program costs by a ratio of nearly 5-to-1. CONCLUSIONS. A heart disease self-management program can reduce health care utilization and potentially yield monetary benefits to a health plan.