August 29, 2007 — A disease management program that focuses on case management and interdisciplinary communication for chronically critically ill patients and their caregivers significantly reduced the cost of care after hospital discharge without increasing the hospital’s costs of delivering care, according to a report in the September issue of the American Journal of Critical Care.
People with chronic conditions account for most healthcare costs and caring for chronically critically ill persons carries the highest costs.
Sara L. Douglas, RN, PhD, Barbara J. Daly, RN, PhD, FAAN, and colleagues from Case Western Reserve University in Cleveland, OH, evaluated how adding the program to the usual care system would affect mortality, health-related quality of life, and resource use in a group of 335 intensive care patients after hospital discharge.
The randomized experimental study was performed at University Hospitals of Cleveland, a 950-bed tertiary care facility associated with Case Western Reserve University. It is the first description of such an intervention among patients with multiple conditions occurring at the same time, the so-called comorbid conditions that are common among chronically critically ill patients.
Chronically critically ill patients often have high costs of care and poor outcomes, and therefore can benefit from a disease management program, according to background information in the article. The 335 intensive care patients followed in the study for eight weeks all had received more than three days of mechanical ventilation, placing them at higher risk for death or prolonged hospitalization with multi-organ dysfunction and continuing care needs after discharge.
Among the 180 patients who survived the study period and were readmitted to the hospital, those who were assigned to the disease management program on average had 5.77 fewer hospital days than did those who were not assigned to the program.
“At a mean hospital charge of $3,415 a day,” note the researchers, “this reduction in hospital days represents an average savings of $19,705 per patient. If similar savings were realized for each of the 93 patients in the study who were readmitted, the total reduction in hospital charges would be $1,832,523.”
The disease management program carried out by advanced practice nurses more than paid for itself by reducing readmission-related charges by almost $2 million, the authors said.
The disease management program used in the study did not have a significant impact on the patients’ health-related quality of life, though a greater percentage of patients in the experimental group had “improved” physical health-related quality of life at the end of the intervention period compared with those in the control group. The only significant effect of the intervention was a reduction in the number of days of hospital readmission and therefore a reduction in charges associated with readmission.
This study was supported by a grant from the National Institute of Nursing Research.
For more information: www.ajcconline.org.