Chronic care management linked to lower acute care use in high-risk patients

In an observational pre-post study with a comparison group, researchers evaluated a multidisciplinary chronic care management program among 3,657 high-risk patients in Maryland. Engagement was associated with fewer hospitalizations and emergency department visits and lower acute care spending, but not fewer 30-day readmissions.

Matched analysis included 2,370 patients.
Hospitalizations and ED visits fell more with CCM engagement.
Readmissions did not differ between groups.
Acute care spending was $3,008 lower in the matched analysis.

Researchers assessed a chronic care management (CCM) program delivered by the Johns Hopkins Care Transformation Organization to high-risk patients attributed to Maryland Primary Care Program practices. The observational pre-post study compared 1,219 patients who engaged in CCM with 2,438 sampled patients who did not. The program used registered nurse care managers, with pharmacy, behavioral health and community health worker services available as clinically indicated. Outcomes were measured over six months before and after the index date; analyses included propensity-score matching.

In the matched cohort of 2,370 patients, CCM engagement was associated with greater reductions in hospitalizations (average treatment effect on the treated, −0.22; 95% CI, −0.29 to −0.16) and emergency department visits (−0.20; 95% CI, −0.28 to −0.13). Readmissions did not differ (0.00; 95% CI, −0.03 to 0.03). Acute care expenditures were $3,008 lower among CCM participants in the matched analysis. Participants had higher baseline acute care use than non-engaged patients.

The findings support an association between this program and lower acute care use and spending in a high-risk primary care population. Because the study was observational, residual confounding may remain; the results do not establish that CCM caused the reductions or show whether they apply to other programs or settings.

In practice

For high-risk patients attributed to Maryland Primary Care Program practices supported by the Johns Hopkins Care Transformation Organization, engagement in this multidisciplinary CCM program was associated with lower hospital and ED use and lower acute care expenditures over the study period. The findings may inform evaluation of similar care-coordination programs, but they do not establish a causal benefit: this was an observational pre-post study, and CCM participants had higher baseline acute care use. Readmissions did not differ, and applicability to other programs or settings is uncertain.

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Source

Journal of General Internal Medicine: Association of a Chronic Care Management Model with Health Care Costs and Utilization ↗

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