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Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients.
Am J Manag Care. 2005 Nov; 11(11):701-13.AJ

Abstract

BACKGROUND

Disease management programs are reported to improve clinical and quality-of-life outcomes while simultaneously lowering healthcare costs.

OBJECTIVE

To examine the effectiveness of disease management in improving health-related quality of life (HRQL) among patients with heart failure beyond 12 months.

METHODS

A total of 1069 community-dwelling patients 18 years and older in South Texas with echocardiographic evidence of congestive heart failure were randomly assigned to disease management, augmented disease management, and control groups. They were followed up 18 months. Patients in the control group received usual care. Patients in the intervention groups were assigned a registered nurse as a disease manager who performed telephonic patient education and medication management. Health-related quality-of-life data (based on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were collected 4 times, at 6-month intervals.

RESULTS

Disease management has a limited effect on HRQL. Analysis of the SF-36 health transition measure showed a positive effect of the intervention on self-reported improvement in health at 6 months and at 12 months (P = .04 and P = .004, respectively). However, no effect of disease management was observed across any of the SF-36 components. Women and patients with diastolic heart failure had poorer HRQL scores.

CONCLUSIONS

Participation in disease management has little effect on HRQL outcomes in congestive heart failure. Beneficial effects on the SF-36 scale scores seen at 6 and 12 months were not sustained. Therefore, it is unclear whether disease management can provide long-term improvement in HRQL for patients with congestive heart failure.

Authors+Show Affiliations

Disease Management Center, The University of Texas Health Science Center at San Antonio, 4243 Piedras Drive East, Suite 240, San Antonio, TX 78228, USA. brad.smith@altarum.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16268753

Citation

Smith, Brad, et al. "Disease Management Produces Limited Quality-of-life Improvements in Patients With Congestive Heart Failure: Evidence From a Randomized Trial in Community-dwelling Patients." The American Journal of Managed Care, vol. 11, no. 11, 2005, pp. 701-13.
Smith B, Forkner E, Zaslow B, et al. Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients. Am J Manag Care. 2005;11(11):701-13.
Smith, B., Forkner, E., Zaslow, B., Krasuski, R. A., Stajduhar, K., Kwan, M., Ellis, R., Galbreath, A. D., & Freeman, G. L. (2005). Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients. The American Journal of Managed Care, 11(11), 701-13.
Smith B, et al. Disease Management Produces Limited Quality-of-life Improvements in Patients With Congestive Heart Failure: Evidence From a Randomized Trial in Community-dwelling Patients. Am J Manag Care. 2005;11(11):701-13. PubMed PMID: 16268753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease management produces limited quality-of-life improvements in patients with congestive heart failure: evidence from a randomized trial in community-dwelling patients. AU - Smith,Brad, AU - Forkner,Emma, AU - Zaslow,Barbara, AU - Krasuski,Richard A, AU - Stajduhar,Karl, AU - Kwan,Michael, AU - Ellis,Robert, AU - Galbreath,Autumn Dawn, AU - Freeman,Gregory L, PY - 2005/11/5/pubmed PY - 2005/12/20/medline PY - 2005/11/5/entrez SP - 701 EP - 13 JF - The American journal of managed care JO - Am J Manag Care VL - 11 IS - 11 N2 - BACKGROUND: Disease management programs are reported to improve clinical and quality-of-life outcomes while simultaneously lowering healthcare costs. OBJECTIVE: To examine the effectiveness of disease management in improving health-related quality of life (HRQL) among patients with heart failure beyond 12 months. METHODS: A total of 1069 community-dwelling patients 18 years and older in South Texas with echocardiographic evidence of congestive heart failure were randomly assigned to disease management, augmented disease management, and control groups. They were followed up 18 months. Patients in the control group received usual care. Patients in the intervention groups were assigned a registered nurse as a disease manager who performed telephonic patient education and medication management. Health-related quality-of-life data (based on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were collected 4 times, at 6-month intervals. RESULTS: Disease management has a limited effect on HRQL. Analysis of the SF-36 health transition measure showed a positive effect of the intervention on self-reported improvement in health at 6 months and at 12 months (P = .04 and P = .004, respectively). However, no effect of disease management was observed across any of the SF-36 components. Women and patients with diastolic heart failure had poorer HRQL scores. CONCLUSIONS: Participation in disease management has little effect on HRQL outcomes in congestive heart failure. Beneficial effects on the SF-36 scale scores seen at 6 and 12 months were not sustained. Therefore, it is unclear whether disease management can provide long-term improvement in HRQL for patients with congestive heart failure. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/16268753/Disease_management_produces_limited_quality_of_life_improvements_in_patients_with_congestive_heart_failure:_evidence_from_a_randomized_trial_in_community_dwelling_patients_ L2 - https://www.ajmc.com/pubMed.php?pii=3026 DB - PRIME DP - Unbound Medicine ER -