Impact of a Chronic Disease Management Program on Hospital Admissions and Readmissions in an Australian Population with Heart Disease or Diabetes
Published in Population Health Management
Author(s): G. Brent Hamar, DDS, MPH; Elizabeth Y. Rula, PhD; Aaron Wells, PhD; Carter Coberley, PhD; James E. Pope, MD; and Shaun Larkin, HlthScD
Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary health care utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed. This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospital admissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart disease or diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment; n=5053) to similar nonparticipating members (comparison; n=23,077) using a difference-in-differences approach with the year before program commencement serving as baseline and the subsequent 12 or 18 months serving as the program periods. All outcomes were evaluated for the total study population and for disease-matched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regression controlling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months, treatment members displayed decreases in admissions (both, P≤0.001) and readmissions (both, P≤0.01), and ALOS after 18 months (P≤0.01) versus the comparison group; magnitude of impact increased over time for these 3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, but the diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group, admissions decreased with increasing care calls to members (12 and 18 months, P<0.0001). These results show that MHG successfully reduced the frequency and duration of hospital admissions and presents a promising approach to reduce the burden associated with hospitalizations in populations with chronic disease.
- Sharecare’s program for HCF, an Australian Health Fund, significantly improved outcomes for members with heart disease or diabetes at 12 and 18 months compared to similar, non-en- rolled health fund members.
- Improved outcomes included significant decreases in the frequency and duration of hospital admissions.
- This study is the first large-scale evaluation of an Australian chronic disease management program for multiple conditions and supports the expansion of these programs as a means to reduce the burden associated with chronic disease in Australia.