Linh Phuong Bui1, Felicia Hill-Briggs2, Nola Durkin3, Ariella Apfel3, Patti L Ephraim4, Lindsay Andon5, Hussain S Lalani6, Linda Dunbar5, Lawrence J Appel4, Hsin-Chieh Yeh7. 1. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Viet Nam. 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins HealthCareLLC, Glen Burnie, MD, USA. 3. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. 4. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. 5. Johns Hopkins HealthCareLLC, Glen Burnie, MD, USA. 6. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 7. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. Electronic address: hyeh1@jhmi.edu.
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.
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.
Authors: Kaveh G Shojania; Sumant R Ranji; Kathryn M McDonald; Jeremy M Grimshaw; Vandana Sundaram; Robert J Rushakoff; Douglas K Owens Journal: JAMA Date: 2006-07-26 Impact factor: 56.272
Authors: Michael S Spencer; Ann-Marie Rosland; Edith C Kieffer; Brandy R Sinco; Melissa Valerio; Gloria Palmisano; Michael Anderson; J Ricardo Guzman; Michele Heisler Journal: Am J Public Health Date: 2011-06-16 Impact factor: 9.308
Authors: S L Norris; F M Chowdhury; K Van Le; T Horsley; J N Brownstein; X Zhang; L Jack; D W Satterfield Journal: Diabet Med Date: 2006-05 Impact factor: 4.359
Authors: Walter Palmas; Dana March; Salima Darakjy; Sally E Findley; Jeanne Teresi; Olveen Carrasquillo; José A Luchsinger Journal: J Gen Intern Med Date: 2015-03-04 Impact factor: 5.128