This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (120)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Barbara Riegel, DNSc, RN, CS; Beverly Carlson, MS, RN, CNS, CCRN; Zoe Kopp, RN, MPH; Barbara LePetri, MD; Dale Glaser, PhD; Alan Unger, PhD

Arch Intern Med. 2002;162:705-712.

Background  Case management is believed to promote continuity of care and decrease hospitalization rates, although few controlled trials have tested this approach.

Objective  To assess the effectiveness of a standardized telephonic case-management intervention in decreasing resource use in patients with chronic heart failure.

Methods  A randomized controlled clinical trial was used to assess the effect of telephonic case management on resource use. Patients were identified at hospitalization and assigned to receive 6 months of intervention (n = 130) or usual care (n = 228) based on the group to which their physician was randomized. Hospitalization rates, readmission rates, hospital days, days to first rehospitalization, multiple readmissions, emergency department visits, inpatient costs, outpatient resource use, and patient satisfaction were measured at 3 and 6 months.

Results  The heart failure hospitalization rate was 45.7% lower in the intervention group at 3 months (P = .03) and 47.8% lower at 6 months (P = .01). Heart failure hospital days (P = .03) and multiple readmissions (P = .03) were significantly lower in the intervention group at 6 months. Inpatient heart failure costs were 45.5% lower at 6 months (P = .04). A cost saving was realized even after intervention costs were deducted. There was no evidence of cost shifting to the outpatient setting. Patient satisfaction with care was higher in the intervention group.

Conclusions  The reduction in hospitalizations, costs, and other resource use achieved using standardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches.

From San Diego State University (Dr Riegel and Ms Carlson), the Clinical Research Department, Sharp HealthCare (Dr Riegel and Ms Carlson), and Pacific Science and Engineering Group (Dr Glaser), San Diego, Calif; from San Diego State University (Dr Riegel and Ms Carlson), the Clinical Research Department, Sharp HealthCare (Dr Riegel and Ms Carlson), and Pacific Science and Engineering Group (Dr Glaser), San Diego, Calif; Outcomes Research (Ms Kopp) and Safety Evaluation and Epidemiology (Dr LePetri), Pfizer Inc, New York, NY; and Science Applications International Corporation, Reston, Va (Dr Unger).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2002;162(6):722-723.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A meta-analysis of remote monitoring of heart failure patients.
Klersy et al.
J Am Coll Cardiol 2009;54:1683-1694.
ABSTRACT | FULL TEXT  

A randomized controlled trial of telephone-supported care coordination in patients with congestive heart failure
Wootton et al.
J Telemed Telecare 2009;15:182-186.
ABSTRACT | FULL TEXT  

The Effects of a Disease Management Program on Self-Reported Health Behaviors and Health Outcomes: Evidence From the "Florida: A Healthy State (FAHS)" Medicaid Program
Morisky et al.
Health Educ Behav 2009;36:505-517.
ABSTRACT  

Long-Term Cost-Effectiveness of Disease Management in Systolic Heart Failure
Miller et al.
Med Decis Making 2009;29:325-333.
ABSTRACT  

Tele-assistance in chronic respiratory failure patients: a randomised clinical trial
Vitacca et al.
Eur Respir J 2009;33:411-418.
ABSTRACT | FULL TEXT  

What Works In Chronic Care Management: The Case Of Heart Failure
Sochalski et al.
Health Aff (Millwood) 2009;28:179-189.
ABSTRACT | FULL TEXT  

Pediatric Personal Health Records: Current Trends and Key Challenges
Britto and Wimberg
Pediatrics 2009;123:S97-S99.
ABSTRACT | FULL TEXT  

Transferring disease management and health promotion programs to other countries: critical success factors
Azarmina et al.
HEALTH PROMOT INT 2008;23:372-379.
ABSTRACT | FULL TEXT  

Optimized post-operative surveillance of permanent pacemakers by home monitoring: the OEDIPE trial
Halimi et al.
Europace 2008;10:1392-1399.
ABSTRACT | FULL TEXT  

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
Antonicelli et al.
J Telemed Telecare 2008;14:300-305.
ABSTRACT | FULL TEXT  

Home monitoring remote control of pacemaker and implantable cardioverter defibrillator patients in clinical practice: impact on medical management and health-care resource utilization
Ricci et al.
Europace 2008;10:164-170.
ABSTRACT | FULL TEXT  

Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians
Qaseem et al.
ANN INTERN MED 2008;148:141-146.
ABSTRACT | FULL TEXT  

Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring
Clark et al.
Eur J Heart Fail 2007;9:1104-1111.
ABSTRACT | FULL TEXT  

The application of telemedicine to geriatric medicine
Brignell et al.
Age Ageing 2007;36:369-374.
ABSTRACT | FULL TEXT  

Telephone interventions for disease management in heart failure
Grancelli and Ferrante
BMJ 2007;334:910-911.
FULL TEXT  

Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial.
Dietrich et al.
ANN INTERN MED 2006;144:563-571.
ABSTRACT | FULL TEXT  

A telephone intervention reduced combined all cause mortality or admission for worsening heart failure in chronic heart failure
Harkness
Evid. Based Nurs. 2006;9:55-55.
FULL TEXT  

Evaluating the Effectiveness of Home Health as a Disease Management Strategy
Linden
Home Health Care Management Practice 2006;18:216-222.
ABSTRACT  

Health Status Identifies Heart Failure Outpatients at Risk for Hospitalization or Death
Heidenreich et al.
J Am Coll Cardiol 2006;47:752-756.
ABSTRACT | FULL TEXT  

Medication and Dietary Compliance Beliefs in Heart Failure
Bennett et al.
West J Nurs Res 2005;27:977-993.
ABSTRACT  

Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis
Roccaforte et al.
Eur J Heart Fail 2005;7:1133-1144.
ABSTRACT | FULL TEXT  

Heart failure programmes in countries with a primary care-based health care system. Are additional trials necessary? Design of the DEAL-HF study
de la Porte et al.
Eur J Heart Fail 2005;7:910-920.
ABSTRACT | FULL TEXT  

Predicting Persistently High Primary Care Use
Naessens et al.
Ann Fam Med 2005;3:324-330.
ABSTRACT | FULL TEXT  

Systematic review of multidisciplinary interventions in heart failure
Holland et al.
Heart 2005;91:899-906.
ABSTRACT | FULL TEXT  

Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure
Thompson et al.
Eur J Heart Fail 2005;7:377-384.
ABSTRACT | FULL TEXT  

Financial aspects of heart failure programs of care
Stewart
Eur J Heart Fail 2005;7:423-428.
ABSTRACT | FULL TEXT  

Heart failure case disease management program: a pilot study of home telemonitoring versus usual care
Capomolla et al.
Eur Heart J Suppl 2004;6:F91-F98.
ABSTRACT | FULL TEXT  

Care Management for Low-Risk Patients with Heart Failure: A Randomized, Controlled Trial
DeBusk et al.
ANN INTERN MED 2004;141:606-613.
ABSTRACT | FULL TEXT  

Deconstructing Heart Failure Disease Management
Wagner
ANN INTERN MED 2004;141:644-646.
FULL TEXT  

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
Gonseth et al.
Eur Heart J 2004;25:1570-1595.
ABSTRACT | FULL TEXT  

Heart failure clinics and outpatient management: review of the evidence and call for quality assurance
Gustafsson and Arnold
Eur Heart J 2004;25:1596-1604.
ABSTRACT | FULL TEXT  

Management programmes for heart failure
Cheng and Ng
Heart 2004;90:972-974.
FULL TEXT  

Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials
McAlister et al.
J Am Coll Cardiol 2004;44:810-819.
ABSTRACT | FULL TEXT  

Improving Quality of Care Through Disease Management: Principles and Recommendations From the American Heart Association's Expert Panel on Disease Management
Faxon et al.
Stroke 2004;35:1527-1530.
FULL TEXT  

Improving Quality of Care Through Disease Management: Principles and Recommendations From the American Heart Association's Expert Panel on Disease Management
Faxon et al.
Circulation 2004;109:2651-2654.
FULL TEXT  

Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure: A Meta-analysis
Phillips et al.
JAMA 2004;291:1358-1367.
ABSTRACT | FULL TEXT  

Reducing Acute Adverse Outcomes in Youths With Type 1 Diabetes: A Randomized, Controlled Trial
Svoren et al.
Pediatrics 2003;112:914-922.
ABSTRACT | FULL TEXT  

Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards
De Geest et al.
Eur J Heart Fail 2003;5:557-567.
ABSTRACT | FULL TEXT  

Telephone consultations
Car and Sheikh
BMJ 2003;326:966-969.
FULL TEXT  

Application of a Depression Management Office System in Community Practice: A Demonstration
Dietrich et al.
J Am Board Fam Med 2003;16:107-114.
ABSTRACT | FULL TEXT  

OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Cognitive Impairment in Heart Failure: Issues of Measurement and Etiology
Riegel et al.
Am J Crit Care 2002;11:520-528.
ABSTRACT | FULL TEXT  

Practical Utility of Case-Management Telephone Intervention in Heart Failure?
Peterson and Riegel
Arch Intern Med 2002;162:2142-2143.
FULL TEXT  

Improving Outcomes in Heart Failure: It's Not Unusual Beyond Usual Care
Moser and Mann
Circulation 2002;105:2810-2812.
FULL TEXT