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Case management in a heterogeneous congestive heart failure population: a randomized controlled trial

Ann S Laramee1, Susan K Levinsky, Jesse Sargent

  • 1Department of Quality and Care Management, Fletcher Allen Health Care Office of Patient Oriented Research, University of Vermont/Fletcher Allen Health Care, Burlington,VT 05401, USA.

Archives of Internal Medicine
|April 16, 2003
PubMed

Insights

Congestive heart failure (CHF) case management (CM) did not reduce 90-day readmissions in a diverse patient group. However, CM improved medication adherence and reduced healthcare costs for CHF patients.

Area of Science:

  • Cardiology
  • Health Services Research
  • Clinical Trials

Background:

  • Previous studies linked congestive heart failure (CHF) case management (CM) to reduced readmissions in homogeneous settings.
  • The effectiveness of CHF CM in heterogeneous populations remained unclear.

Purpose of the Study:

  • To evaluate the impact of CHF CM on 90-day readmission rates in a heterogeneous patient population.
  • To assess the effect of CM on healthcare costs and treatment adherence.

Main Methods:

  • A randomized controlled trial involving 287 patients hospitalized with CHF.
  • Intervention included discharge planning, patient education, telephone follow-up, and medication optimization.
  • Comparison was made against usual care.

Main Results:

  • No significant difference in 90-day readmission rates between CM and usual care groups (37%).
  • The CM group experienced a 14% reduction in total costs and a 26% reduction in readmission costs.
  • CM patients showed better adherence to the overall treatment plan, though not specifically to medication dosages.

Conclusions:

  • The generalizability of improved CHF outcomes with CM is limited in heterogeneous settings.
  • Lack of coordinated care and accessibility issues in non-networked settings may hinder CM effectiveness.
  • Subgroup analysis indicated potential benefit for local patients seeing a cardiologist.
Abstract

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