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Keywords:

  • chronic disease/illness;
  • care manager;
  • comorbidity;
  • utilization;
  • medical home

OBJECTIVES: To explore changes in mortality and hospital usage for chronically ill seniors enrolled in a multidisease care management program, Care Management Plus (CMP).

DESIGN: Controlled clinical trial with seven intervention and six control clinics with additional patient-level matching.

SETTING: Intermountain Health Care, a large health system in Utah; seven intervention and six control clinics.

PARTICIPANTS: Three thousand four hundred thirty-two senior patients (≥65) enrolled in Medicare.

INTERVENTION: The intervention employed nurse care managers supported by specialized information technology in primary care to manage chronically ill patients (2002–2005).

MEASUREMENTS: Mortality and hospitalization data were collected from clinical records and Medicare billing.

RESULTS: One thousand one hundred forty-four intervention patients were matched to 2,288 controls. Average age was 76.2; average comorbidity score was 2.3±1.1; 75% of patients had two or more chronic diseases. Survival analyses showed lower mortality and slightly more emergency department visits for care managed patients than for controls. In patients with diabetes mellitus, the intervention resulted in significantly lower mortality at 1 year (6.2%, vs 10.6% for controls) and at 2 years (12.9% vs 18.2%). Hospitalization rate was lower (21.0%, vs. 24.2% for controls) at 1 year and substantially more so at the 2-year follow-up.

CONCLUSION: CMP was successful in reducing death for all patients. For complex patients with diabetes mellitus in the intervention group, death and hospital usage were lower. Per clinic, hypothesized savings from decreased hospitalizations was $17,384 to $70,349.