Effectiveness Of Disease Management Programs Research Articles

Association of Participation in Disease Management Programs and Health-Related Quality of Life in Korean Population: Results from the Korea National Health and Nutrition Examination Survey IV and V (2007-2012).

Background:The high prevalence of chronic diseases has been an ongoing public concern. The psychological factors, including lack of social support and perceived lack of control, were found to be highly associated with an increased risk of the diseases. In fact, the effect of disease management programs (DMP) in patients diagnosed with chronic diseases were assessed in multiple studies to measure health-related quality of life (HR = QoL), which measured in the EuroQol 5-Dimension Questionnaire (EQ-5D) index score, also known as self-perceived health.Methods:The study was conducted using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012 and through descriptive statistics and multiple linear regression to investigate the association of participation in DMP and the EQ-5D index score.Results:The results revealed that the subjects diagnosed with hypertension were shown to have a lower quality of life to those without the diagnosis (P < .05). Moreover, in the hypertensive Korean population, DMP did not show any statistically significant impact on the EQ-5D index score (P > .05).Conclusion:Our study has assessed the association of DMP and EQ-5D index score in hypertensive patients only although it is still uncertain the effect of DMP on other chronic diseases therefore, further studies should be conducted to investigate the importance of DMP in Korea for the patients with such diseases in improving their quality of life.

Evaluation of a nurse-led intervention program in heart failure: A randomized trial

Background and objectiveSeveral trials have evaluated the effect of disease management programs in heart failure (HF) with diverse results. The aim of this study was to develop a simple nurse-led clinic intervention program for patients with HF and assess whether this intervention positively affects the prognosis of patients, their care costs and perceived quality of life (QoL). MethodsBetween 2011 and 2013, 127 patients with reduced ejection fraction were prospectively randomly allocated (1:2) to standard care or intervention program. Primary composite endpoint was all-cause mortality and hospital readmissions. Secondary endpoints were all-cause mortality, all-cause hospital readmissions, readmissions for HF, time to first readmission and QoL improvements assessed by “Minnesota Living with Heart Failure Questionnaire” (MLHFQ). An intention-to-treat analysis was performed. ResultsAfter a median follow-up of 2-years, no differences were found in the primary composite endpoint. Likewise, there were no differences between groups in the predefined secondary endpoints of mortality and readmissions from any cause. However, in the intervention group, readmissions for HF were significantly reduced (35% vs. 18%; p=0.04) and QoL significantly improved (MLHFQ±SD: 2.29±14 vs. 10.9±14.75; p=0.04). ConclusionsIn patients with HF, the use of a nurse-led intervention program significantly improves perceived QoL and reduce HF hospital readmissions.

Evaluation of a nurse-led intervention program in heart failure: A randomized trial

Background and objectiveSeveral trials have evaluated the effect of disease management programs in heart failure (HF) with diverse results. The aim of this study was to develop a simple nurse-led clinic intervention program for patients with HF and assess whether this intervention positively affects the prognosis of patients, their care costs and perceived quality of life (QoL). MethodsBetween 2011 and 2013, 127 patients with reduced ejection fraction were prospectively randomly allocated (1:2) to standard care or intervention program. Primary composite endpoint was all-cause mortality and hospital readmissions. Secondary endpoints were all-cause mortality, all-cause hospital readmissions, readmissions for HF, time to first readmission and QoL improvements assessed by “Minnesota Living with Heart Failure Questionnaire” (MLHFQ). An intention-to-treat analysis was performed. ResultsAfter a median follow-up of 2-years, no differences were found in the primary composite endpoint. Likewise, there were no differences between groups in the predefined secondary endpoints of mortality and readmissions from any cause. However, in the intervention group, readmissions for HF were significantly reduced (35% vs. 18%; p=0.04) and QoL significantly improved (MLHFQ±SD: 2.29±14 vs. 10.9±14.75; p=0.04). ConclusionsIn patients with HF, the use of a nurse-led intervention program significantly improves perceived QoL and reduce HF hospital readmissions.

A novel integrated care concept (NICC) versus standard care in the treatment of chronic cardiovascular diseases: protocol for the randomized controlled trial CardioCare MV

BackgroundCardiovascular diseases are the major cause of death globally and represent a major economic burden on health care systems. Positive effects of disease management programs have been shown for patients with heart failure (HF). Remote monitoring and telemonitoring with active intervention are beneficial in atrial fibrillation (AF) and therapy-resistant hypertension (TRH), respectively. For these patients, we have developed a novel integrated care concept (NICC) which combines telemedicine with intensive support by a care center, including a call center, an integrated care network including inpatient and outpatient care providers and guideline therapy for patients.MethodsThe aim of the study is to demonstrate the superiority of NICC over guideline therapy alone. The trial is designed as open-label, bi-center, parallel-group design with two groups and a blinded observer. Patients will be included if they are either inpatients or if they are referred to the outpatient clinic of the hospitals by their treating physician. Randomization will be done individually with stratification by cardiovascular disease (AF, HF, TRH), center and admission type. Primary endpoints are based on the 1-year observation period after randomization. The first primary endpoint is the composite endpoint consisting of mortality, stroke and myocardial infarction. The number of hospitalizations form the second primary endpoint. The third primary endpoint is identical to the first primary endpoint plus cardiac decompensation. Adjustments for multiple testing are done using a fall-back strategy. Secondary endpoints include patient adherence, health care costs, quality of life, and safety. A sample size of 2930 gives 80% power at the two-sided 2.5% test level for the first primary endpoint. The power for the second primary endpoint is 99.8% at this sample size, and it is 80% with 1086 patients.DiscussionThis study will inform care providers whether quality of care can be improved by an integrated care concept providing telemedicine through a round-the-clock call center approach. We expect that cost of the NICC will be lower than standard care because of reduced hospitalizations. If the study has a positive result, NICC is planned to be immediately rolled out in the federal state of Mecklenburg-West Pomerania and other federal states in Germany. The trial will also guide additional research to disentangle the effects of this complex intervention.Trial registrationDRKS, ID: DRKS00013124. Registered on 5 October 2017;ClinicalTrials.gov, ID: NCT03317951. Registered on 17 October 2017.

Effect of disease management programs on stroke recurrence in patients with ischemic stroke

Objective To explore the effect of disease management programs (DMPs) on prevention of recurrence of ischemic stroke (IS) . Methods This study was a prospective follow-up study which included 182 subjects with IS between January 2012 and December 2013. These subjects were divided into study group (n=88) and control group (n=94) randomly. The patients of study group received six months of DMPs and the patients of control group received conventional health education at discharge. Results The follow-up was carried out 33 months (6-45 months) averagely in two groups. 5 cases recurred IS in the study group, with the time to recurrence of 20 (10-35) months, and 3-year recurrence-free survival rate was 92.8%; 14 cases recurred IS in the control group, with the time to recurrence of 13 (4-28) months, and 3-year recurrence-free survival rate was 84.3%. Recurrence-free survival rate in study group was significantly increased than the control group (χ2=4.371, P<0.05) . Conclusions Disease management programs can significantly reduce the recurrence of ischemic stroke, which is worthy of applying in clinical work further. Key words: Recurrence; Disease management programs; Ischemic stroke

Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia

In recent decades, most states’ Medicaid programs have introduced disease management programs for chronically ill beneficiaries. Interventions assist beneficiaries and their health care providers to appropriately manage chronic health condition(s) according to established clinical guidelines. Cost containment has been a key justification for the creation of these programs despite mixed evidence they actually save money. This study evaluates the effects of a disease management program in Georgia by exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand beneficiaries. Expenditures for medical claims decreased an average of $89 per person per month for the high- and moderate-risk groups, but those savings were not large enough to offset the total costs of the program. Impacts varied by the intensity of interventions, over time, and across disease groups. Heterogeneous treatment effect analysis indicates that decreases in medical expenditures were largest at the most expensive tail of the distribution.

Pilotstudie zur Evaluation des DMP Koronare Herzkrankheit – Entwicklung einer Methodik und erste Ergebnisse

Regarding the effectiveness of disease management programs (DMPs) in Germany, several studies have been published on the DMP for type 2 diabetes. This pilot study provides methodological insights into evaluating the DMP for coronary heart disease (CHD), which currently includes 1.7 million participants, and reveals trends in healthcare outcomes for mortality, guideline adherent prescribing and costs. Major methodological challenges that need to be considered for the development of an appropriate matching method for this indication have been identified. The results show positive trends in favor of the DMP regarding mortality, costs and medication according to guidelines. A matching design is applicable to the CHD indication; the knowledge gained regarding the quality of care can be used for a targeted development of the program.

Payment and economic evaluation of integrated care.

Chronic diseases have an increasingly negative impact on (1) population health by increasing morbidity and mortality, (2) society by increasing health inequalities and burden to informal caregivers, and (3) economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply). Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

Baseline Feature of a Randomized Trial Assessing the Effects of Disease Management Programs for the Prevention of Recurrent Ischemic Stroke

Comprehensive and long-term patient education programs designed to improve self-management can help patients better manage their medical condition. Using disease management programs (DMPs) that were created for each of the risk factor according to clinical practice guidelines, we evaluate their influence on the prevention of stroke recurrence. This is a randomized study conducted with ischemic stroke patients within 1 year from their onset. Subjects in the intervention group received a 6-month DMPs that included self-management education provided by a nurse along with support in collaboration with the primary care physician. Those in the usual care group received ordinary outpatient care. The primary end point is a difference of the Framingham risk score-general cardiovascular disease 10-year risk [corrected]. Patients were enrolled for 2 years with plans for a 2-year follow-up after the 6-month education period (total of 30 months). A total of 321 eligible subjects (average age, 67.3 years; females, 96 [29.9%]), including 21 subjects (6.5%) with transient ischemic attack, were enrolled in this study. Regarding risk factors for stroke, 260 subjects (81.0%) had hypertension, 249 subjects (77.6%) had dyslipidemia, 102 subjects (31.8%) had diabetes mellitus, 47 subjects (14.6%) had atrial fibrillation, and 98 subjects (30.5%) had chronic kidney disease. There were no significant differences between the 2 groups with respect to subject characteristics. This article describes the rationale, design, and baseline features of a randomized controlled trial that aimed to assess the effects of DMPs for the secondary prevention of stroke. Subject follow-up is in progress and will end in 2015.

Disease Management: The Need for a Focus on Broader Self-Management Abilities and Quality of Life.

The study objective was to investigate long-term effects of disease management programs (DMPs) on (1) health behaviors (smoking, physical exercise); (2) self-management abilities (self-efficacy, investment behavior, initiative taking); and (3) physical and mental quality of life among chronically ill patients. The study also examined whether (changes in) health behaviors and self-management abilities predicted quality of life. Questionnaires were sent to all 5076 patients participating in 18 Dutch DMPs in 2010 (T0; 2676 [53%] respondents). Two years later (T1), questionnaires were sent to 4350 patients still participating in DMPs (1722 [40%] respondents). Structured interviews were held with the 18 DMP project leaders. DMP implementation improved patients' health behavior and physical quality of life, but mental quality of life and self-management abilities declined over time. Changes in patients' investment behavior predicted physical quality of life at T1 (P<.001); physical activity, investment behavior (both P<.05), and self-efficacy (P<.01) at T0, and changes in self-efficacy and investment behavior (both P<.001) predicted patients' mental quality of life at T1. The long-term benefits of these DMPs include successful improvement of chronically ill patients' health behaviors and physical quality of life. However, these programs were not able to improve or maintain broader self-management abilities or mental quality of life, highlighting the need to focus on these abilities and overall quality of life. As coproducers of care, patients should be stimulated and enabled to manage their health and quality of life.

Effectiveness of a follow-up program for elderly heart failure patients after hospital discharge. A randomized controlled trial

PurposeManagement programs for high-risk heart failure (HF) patients reduce admission rates, improve quality of life and survival, and lower costs. These benefits are controversial in elderly patients because these individuals are frequently excluded from the studies. Our aim was to evaluate the effectiveness of disease management programs (DMPs) for HF elderly patients attending a geriatric day care hospital (GDCH) subsequent to hospital discharge. MethodsA randomized prospective study was performed using 117 HF patients who were divided into two groups as follows: 59 patients undergoing an interventional program including health education, therapeutic control, and close follow-up in a GDCH; and 58 patients receiving standard healthcare. Results were measured in terms of event-free survival, where “event” is defined as readmission or mortality for any cause. ResultsThe mean age was 85years, and 73% of the patients were women. After a year of follow-up, the intervention group had fewer patients with events compared with the control group (27 vs. 38 patients), which indicates a 30% reduction (RR: 2.25; 95% CI: 1.07–4.74; P=0.032). The probability of having an event between the first visit and the year of follow-up was significantly lower in the intervention group (log-rank: 5.79; P=0.016). Moreover, the quality of life improved significantly in the intervention group (P=0.035). ConclusionA developed DMP in a GDCH improves the event-free survival and the quality of life in elderly patients with HF. Trial registrationisrctn.org identifier: ISRCTN10823032.

Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines

Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.

A Randomized Controlled Pilot Study of the Japanese Heart Failure Self-Management Program: Impacts on Heart Failure Knowledge and Clinical Outcomes

Unlike in Western countries, effectiveness of disease management programs on heart failure (HF) patients has not yet been established in Japan so far. We therefore developed HF educational program and evaluated its efficacy in a randomized controlled trial among Japanese patients.

A predictive modeling approach to increasing the economic effectiveness of disease management programs

Predictive Modeling (PM) techniques are gaining importance in the worldwide health insurance business. Modern PM methods are used for customer relationship management, risk evaluation or medical management. This article illustrates a PM approach that enables the economic potential of (cost-) effective disease management programs (DMPs) to be fully exploited by optimized candidate selection as an example of successful data-driven business management. The approach is based on a Generalized Linear Model (GLM) that is easy to apply for health insurance companies. By means of a small portfolio from an emerging country, we show that our GLM approach is stable compared to more sophisticated regression techniques in spite of the difficult data environment. Additionally, we demonstrate for this example of a setting that our model can compete with the expensive solutions offered by professional PM vendors and outperforms non-predictive standard approaches for DMP selection commonly used in the market.

Organization of Diabetes Care

Organization of Diabetes Care

The impact of population-based disease management services for selected chronic conditions: the Costs to Australian Private Insurance--Coaching Health (CAPICHe) study protocol.

BackgroundRecent evidence from a large scale trial conducted in the United States indicates that enhancing shared decision-making and improving knowledge, self-management, and provider communication skills to at-risk patients can reduce health costs and utilisation of healthcare resources. Although this trial has provided a significant advancement in the evidence base for disease management programs it is still left for such results to be replicated and/or generalised for populations in other countries and other healthcare environments. This trial responds to the limited analyses on the effectiveness of providing chronic disease management services through telephone health coaching in Australia. The size of this trial and it's assessment of cost utility with respect to potentially preventable hospitalisations adds significantly to the body of knowledge to support policy and investment decisions in Australia as well as to the international debate regarding the effect of disease management programs on financial outcomes.MethodsIntention to treat study applying a prospective randomised design comparing usual care with extensive outreach to encourage use of telephone health coaching for those people identified from a risk scoring algorithm as having a higher likelihood of future health costs. The trial population has been limited to people with one or more of the following selected chronic conditions: namely, low back pain, diabetes, coronary artery disease, heart failure, and chronic obstructive pulmonary disease. This trial will enrol at least 64,835 sourced from the approximately 3 million Bupa Australia private health insured members located across Australia. The primary outcome will be the total (non-maternity) cost per member as reported to the private health insurer (i.e. charged to the insurer) 12 months following entry into the trial for each person. Study recruitment will be completed in early 2012 and the results will be available in late 2013.DiscussionIf positive, CAPICHe will represent a potentially cost-effective strategy to improve health outcomes in higher risk individuals with a chronic condition, in a private health insurance setting.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12611000580976

Predictors of dropout in the German disease management program for type 2 diabetes

BackgroundTo improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.MethodsWe used routine data provided by a statutory health insurance fund from the regions North Rhine, North Wurttemberg and Hesse. As part of the German DMP for type 2 diabetes, the insurance fund received regular documentation of all members participating in the program. We followed 10,989 patients who enrolled in the DMP between July 2004 and December 2005 until the end of 2007 to study how many patients dropped out of the program. Dropout was defined based on the discontinuation of program documentation on a particular patient, excluding situations in which the patient died or left the insurance fund. Predictors of dropout, assessed at the time of program enrolment, were explored using logistic regression analysis.Results5.5% of the patients dropped out of the disease management program within the observation period. Predictors of dropout at the time of enrolment were: region; retirement status; the number of secondary diseases; presence of a disabling secondary disease; doctor's recommendations to stop smoking or to seek nutritional counselling; and the completion and outcome of the routine foot and eye exams. Different trends of dropout were observed among retired and employed patients: retired patients of old age, who possibly drop out of the program due to other health care priorities and employed people of younger age who have not yet developed many secondary diseases, but were recommended to change their lifestyle.ConclusionsOverall, dropout rates for the German disease management programs for type 2 diabetes were low compared to other studies. Factors assessed at the time of program enrolment were predictive of later dropout and should be further studied to provide information for future program improvements.

Rationale and design of the Japanese Heart Failure Outpatients Disease Management and Cardiac Evaluation (J-HOMECARE)

Although many studies have demonstrated the efficacy of disease management programs on mortality, morbidity, quality of life (QOL), and medical cost in patients with heart failure (HF), no study has focused on psychological status as an outcome of disease management. In addition, very little information is available on the effectiveness of disease management programs in other areas than the USA and Europe. The Japanese Heart Failure Outpatients Disease Management and Cardiac Evaluation (J-HOMECARE) is a randomized controlled trial in which 156 patients hospitalized with HF will be randomized into usual care or a home-based disease management arm receiving comprehensive advice and counseling by visiting nurses during the initial 2 months and telephone follow-up for the following 4 months after discharge. This study evaluates depression and anxiety (Hospital Anxiety and Depression Scale), mortality, readmission due to HF, and QOL (Short Form-8). Data are collected during index hospitalization and then 2, 6, and 12 months after discharge. This study started in December 2007, and the final results are expected in 2011. The J-HOMECARE will provide important information on the efficacy of disease management for psychological status as well as the effective components of disease management for patients with HF. (ClinicalTrials.gov number, NCT01284400).

Bioelectrical impedance vector analysis (BIVA) in stable and non-stable heart failure patients: A pilot study

Heart failure (HF) patients have a high morbidity and mortality and often require numerous visits and hospital readmissions related to fluid retention [ [1] Gonseth J. Guallar-Castillon P. Banegas J.R. Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004; 18: 1570-1595 Crossref Scopus (366) Google Scholar ]. Biompedance is a method of body composition analysis studied in HF in different ways such as impedance cardiography [ [2] Thompson B. Drazner M.H. Dries D.L. Yancy C.W. Systolic time ratio by impedance cardiography to distinguish preserved vs impaired left ventricular systolic function in heart failure. Congest Heart Fail. 2008; 14: 261-265 Crossref PubMed Scopus (16) Google Scholar ] or as a home monitoring method in telemedicine systems [ [3] Radai M.M. Arad M. Zlochiver S. Krief H. Engelman T. Abboud S. A novel telemedicine system for monitoring congestive heart failure patients. Congest Heart Fail. 2008; 14: 239-244 Crossref PubMed Scopus (8) Google Scholar ], but little data exist about the analysis of the components of the impedance vector (BIVA-Bioimpedance Vector Analysis-) in HF. The result of a measurement using bioelectrical impedance is a vector (Z vector) in which the opposition of an alternating current flow through intra- and extra-cellular ionic solutions is resistance (R), and the capacitance of biological tissues, is reactance (Xc). The arc tangent of the vector is the phase angle (PA) [ [4] Grimnes S. Martinsen Ø.G. Bioimpedance and bioelectricity basics. in: Academic Press, London2000: 114-115 Google Scholar ]. BIVA is a validated method where the components of the impedance vector are normalized by the height (H) of the subjects (R/H and Xc/H) [ [5] Piccoli A. Pastori G. BIVA software. Department of Medical and Surgical Sciences, University of Padova, Italy2002 Google Scholar ]. They are represented on confidence and tolerance ellipses in an RXc-graph [ [6] Piccoli A. Rossi B. Pillon L. Bucciante G. A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int. 1994; 46: 534-539 Crossref PubMed Scopus (502) Google Scholar ] separated by gender [ 7 Piccoli A. Nigrelli S. Caberlotto A. Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations. Am J Clin Nutr. 1995; 61: 269-270 PubMed Google Scholar , 8 Piccoli A. Pillon L. Dumler F. Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores. Nutrition. 2002; 18: 156-170 Google Scholar ]. Many populations have already been characterized by BIVA [ 7 Piccoli A. Nigrelli S. Caberlotto A. Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations. Am J Clin Nutr. 1995; 61: 269-270 PubMed Google Scholar , 8 Piccoli A. Pillon L. Dumler F. Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores. Nutrition. 2002; 18: 156-170 Google Scholar , 9 Piccoli A. Fanos V. Peruzzi L. et al. Reference values of the bioelectical impedance vector in neonates in the first week after birth. Nutrition. 2002; 18: 17-21 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 10 De Palo T. Messina G. Edefonti A. et al. Normal values of the bioelectrical impedance vector in childhood and puberty. Nutrition. 2000; 16: 417-424 Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar , 11 Piccoli A. Brunani A. Savia G. Discriminating between body fat and fluid changes in the obese adult using bioimpedance vector analysis. Int J Obes. 1998; 22: 97-104 Crossref PubMed Scopus (128) Google Scholar , 12 Nescolarde L. Piccoli A. Doñate T. Rosell J. Bioelectrical impedance vector analysis in haemodialysis patients: relation between oedema and mortality. Physiol Meas. 2004; 25: 1271-1280 Crossref PubMed Scopus (63) Google Scholar , 13 Nescolarde L. Doñate T. Piccoli A. Rosell J. Comparison of segmental with whole-body impedance measurements in peritoneal dialysis patients Med. Eng Phys. 2008; 30: 817-824 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 14 Toso S. Piccoli A. Gusella M. Menon D. Bononi A. Crepaldi G. Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance vector analysis. Nutrition. 2000; 16: 120-124 Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar ], but little data exist in HF. The aim of this pilot study was to assess the usefulness of BIVA in assessing the hydration state in stable and non-stable HF patients.

The paradox of readmission: Effect of a quality improvement program in hospitalized patients with heart failure

Congestive heart failure (CHF) is an increasingly common condition associated with significant hospital resource utilization. Initiating better disease management at the time of initial hospital admission has the potential to reduce readmissions. To evaluate the impact of a multifaceted quality improvement program on 12-month hospital utilization in patients admitted to hospital with CHF. Prospective longitudinal study comparing baseline and intervention cohorts. All consecutive patients with CHF discharged alive from 3 metropolitan hospitals during the baseline (October 1, 2000 to April 17, 2001) and intervention (February 15, 2002 to August 31, 2002) study periods. Active prospective case-finding identified 220 baseline and 235 intervention participants; full data was available on 197 baseline and 219 intervention participants. Education and performance feedback for hospital and primary care practitioners; clinical decision support tools; individualized, guideline-based treatment plans; patient education and self-management support; and improved hospital-community integration. Twelve-month all-cause hospital readmission, 12-month mortality, readmission-free survival, heart failure-specific readmission, and total hospital days over 12 months. Intervention patients had a higher rate of all-cause readmission (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.10-2.46) but a trend to reduction in mortality (OR = 0.68; 95% CI = 0.44-1.07). There was no difference in frequency of hospitalizations per year, number of hospital days, or the composite outcome of death or readmission. The intervention improved care processes and may have reduced mortality, but at the cost of higher readmission rates. Better understanding of intervention components, intensity, and targeting may optimize the effectiveness of disease management programs.