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Impact Evaluation of a System-Wide Chronic Disease Management Program on Health Service Utilisation: A
Laurent Billot1,2, Kate Corcoran1, Alina McDonald1
1The George Institute for Global Health, Sydney, New South Wales, Australia.
Plos Medicine
|June 9, 2016
Summary
The New South Wales Health Chronic Disease Management Program (CDMP) increased avoidable hospital admissions in participants compared to controls. However, it did not impact other hospitalizations or death rates, suggesting careful control group selection is vital for intervention assessment.
Area of Science:
- Health Services Research
- Chronic Disease Management
- Public Health Interventions
Background:
- The New South Wales Health (NSW Health) Chronic Disease Management Program (CDMP) targets adults at risk of hospitalization for conditions like diabetes and heart disease.
- The program integrates care coordination across multiple sectors and health coaching for self-management.
- Implementation varied across regional health services to suit local needs and resources.
Purpose of the Study:
- To evaluate the health service utilization impact of the CDMP using a propensity-matched cohort study.
- To compare avoidable and unplanned hospitalizations, readmissions, bed days, ED presentations, and all-cause mortality between CDMP participants and matched controls.
Main Methods:
- A cohort of 41,303 CDMP participants enrolled between 2011-2013 was matched 1:1 with controls not in the program.
- Propensity score matching was used to balance baseline characteristics, including prior health service utilization.
- Primary outcome was avoidable hospitalizations; secondary outcomes included unplanned utilization and all-cause death, with a median follow-up of 15 months.
Main Results:
- CDMP participants showed a significantly higher adjusted yearly rate of avoidable hospital admissions (1.70 times higher) compared to controls.
- Increased utilization was also observed for unplanned hospitalizations, readmissions, and bed days in the CDMP group.
- No significant difference was found in all-cause death or non-avoidable hospitalizations between the groups.
Conclusions:
- The CDMP was associated with an increase in avoidable hospital admissions but not other hospitalizations or death, possibly due to identifying previously unrecognized needs.
- Health service utilization sharply decreased after a peak for both groups, reflecting natural patient trajectories.
- The study underscores the importance of carefully selected control groups for accurately assessing intervention effectiveness on hospital use.
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