Case management program for patients with chronic heart failure: effectiveness in terms of mortality, hospital admissions and costs.

Abstract

At 360 000 cases annually, heart failure is the most common main diagnosis in adults in German hospitals. Treating heart failure is expensive. This study tested whether patients in the case management program (CMP) "CorBene--Better Care for Patients With Heart Failure" have a lower mortality rate and lower hospital admission and readmission rates than patients receiving regular management. Routine data from a large German statutory health insurance company were analyzed. After propensity score matching, a total of 1202 patients (intervention group versus control group) were studied in relation to the endpoint "hospital admission and readmission rate" and the variables "annual physician contact rate," "mortality," and "inpatient treatment costs." The intervention group showed a lower rate of hospital admission/readmission (6.2%/18.9% versus 16.6%/36.0%; p<0.0001 / p = 0.041). Mortality rates did not differ significantly (5.0% versus 6.7%; p = 0.217). Analysis of hospital admission data showed no significant differences between the groups in terms of length of hospital stay or costs for heart failure-related treatment per hospital stay. However, the average annual costs for inpatient treatment in the CMP group, at €222.22 per patient, were 67.5% lower than the equivalent costs in the control group (€683.88) (p<0.0001). Fewer patients in the intervention group were admitted and readmitted to hospital, and lower inpatient treatment costs were identified. The physician contact rate was higher than in the control group.