National estimates of enrollment in disease management programs in the United States: an analysis of the National Ambulatory Medical Care Survey data.

Disease management (DM) programs have demonstrated improvement in clinical and economic outcomes for patients with chronic conditions; however, the extent of utilization of these programs in the United States is not known. The rate of enrollment in DM programs was estimated using data from the National Ambulatory Medical Care Survey (NAMCS). Logistic regression analysis was used to identify predictors of enrollment in DM programs. The complex sampling design of the NAMCS was accounted in all analyses. The final study sample included 14,405 patient visits and indicated that only 21.3% of patients with at least 1 chronic condition utilize DM programs. Regression analysis demonstrated that patients who visit specialty physicians (excluding internal medicine) are more likely to be enrolled in a DM program than patients who visit general medicine/family practice physicians (P < 0.01). Patients with depression, diabetes, hyperlipidemia, or obesity were significantly more likely to be enrolled in a DM program than patients without these chronic conditions. Enrollment in a DM program was also affected by the total number of chronic conditions--patients with 2-4 chronic conditions were 1.29 times more likely to be enrolled in a DM program than patients with a single chronic condition (P = 0.026). In conclusion, although benefits of DM programs have been documented, their adoption rate remains extremely low. Additional studies are needed to identify other predictors and to tailor interventions to increase the adoption of such programs.