Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?

Linh Phuong Bui, Felicia Hill-Briggs, Nola Durkin, Ariella Apfel, Patti L Ephraim, Lindsay Andon, Hussain S. Lalani, Linda Dunbar, Lawrence Appel, Hsin Chieh Yeh

Research output: Contribution to journalArticle

Abstract

Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08–1.86) and 64% (RR: 1.64; 95% CI: 1.08–2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02–1.42) and 42% (RR:1.42; 95% 1.09–1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): −0.23% (1.59%)). Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.

Original languageEnglish (US)
JournalJournal of Diabetes and its Complications
DOIs
StatePublished - Jan 1 2019

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Patient Acceptance of Health Care
Medicaid
Case Management
Medicare
Patient Readmission
Hospital Emergency Service
Health
Hospitalization
Chronic Disease
Research Design

Keywords

  • case management
  • community health worker
  • diabetes
  • health care utilization

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{558a4d1d6f604544a05a740e1bdc53e5,
title = "Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?",
abstract = "Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42{\%} (rate ratio (RR): 1.42; 95{\%} CI: 1.08–1.86) and 64{\%} (RR: 1.64; 95{\%} CI: 1.08–2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20{\%} (RR: 1.20; 95{\%} 1.02–1.42) and 42{\%} (RR:1.42; 95{\%} 1.09–1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17{\%} (1.50{\%})), with a larger decrease in the high contact group (mean (SD): −0.23{\%} (1.59{\%})). Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.",
keywords = "case management, community health worker, diabetes, health care utilization",
author = "Bui, {Linh Phuong} and Felicia Hill-Briggs and Nola Durkin and Ariella Apfel and Ephraim, {Patti L} and Lindsay Andon and Lalani, {Hussain S.} and Linda Dunbar and Lawrence Appel and Yeh, {Hsin Chieh}",
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T1 - Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?

AU - Bui, Linh Phuong

AU - Hill-Briggs, Felicia

AU - Durkin, Nola

AU - Apfel, Ariella

AU - Ephraim, Patti L

AU - Andon, Lindsay

AU - Lalani, Hussain S.

AU - Dunbar, Linda

AU - Appel, Lawrence

AU - Yeh, Hsin Chieh

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08–1.86) and 64% (RR: 1.64; 95% CI: 1.08–2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02–1.42) and 42% (RR:1.42; 95% 1.09–1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): −0.23% (1.59%)). Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.

AB - Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions. Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08–1.86) and 64% (RR: 1.64; 95% CI: 1.08–2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02–1.42) and 42% (RR:1.42; 95% 1.09–1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): −0.23% (1.59%)). Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.

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KW - health care utilization

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