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Testing the Replicability of a Successful Care Management Program: Results from a Randomized Trial and Likely
G Greg Peterson1, Jelena Zurovac1, Randall S Brown2
1Mathematica Policy Research, Washington, DC.
Health Services Research
|October 26, 2016
Summary
A care management program failed to replicate earlier success in reducing hospitalizations and Medicare costs. The lack of replication was due to improvements in the control group, not worsening outcomes for the intervention group.
Area of Science:
- Health Services Research
- Chronic Disease Management
- Health Economics
Background:
- A prior randomized trial demonstrated the success of an intensive care management program for Medicare beneficiaries with chronic illnesses.
- Replication of this success in a subsequent trial was assessed to determine its generalizability and identify factors influencing outcomes.
Purpose of the Study:
- To evaluate whether a successful care management program could achieve similar results in a later period.
- To investigate potential reasons for any discrepancies in program effectiveness compared to the initial trial.
Main Methods:
- A randomized trial involving 483 Medicare fee-for-service beneficiaries with chronic illnesses in eastern Pennsylvania.
- Comparison of intensive care management services against usual care, with outcomes derived from Medicare claims and nurse contact data.
Main Results:
- The program did not significantly reduce hospitalizations or generate Medicare savings between 2010 and 2014.
- Observed outcomes were statistically different (p < .05) from the first trial (2002-2010), with no significant treatment-control difference in hospitalization rates.
- The control group's improved risk-adjusted hospitalization rate, rather than a decline in the treatment group's outcomes, explained the lack of observed impact.
Conclusions:
- Successful interventions in one trial setting may not consistently replicate in different contexts or timeframes.
- Future replication success may depend on assessing the continued presence of care gaps that the original program addressed.
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