The study – conducted between January 2002 and June 2005 at 13 primary care clinics in Utah – found that deaths among the 1,144 patients in the "intervention" group receiving optimum care, called Care Management Plus (CMP), were significantly lower in the first and second years than among the 2,288 patients in the control group whose members received the usual care.
Seven clinics served the CMP patients and six the control group patients. Each CMP patient was matched with two control patients based on age, hospitalisation records, comorbidity scores, gender, and specific chronic illnesses. The average age of all patients was 76. Three quarters of them had two or more chronic illnesses.
At the CMP clinics, computer tools were combined with a registered nurse who received extra training. Physicians referred patients with complex conditions to the nurse care manager who completed a patient assessment. The care manager then created with the patient a detailed care plan supported by specialised computer tools, including structured protocols and guidelines for various conditions and diseases, a care management tracking (CMT) database and detailed electronic patient worksheet. The care manager suggested medication changes or other treatments when indicated, helping physicians respond to patients' needs more quickly and efficiently. The tools helped organise and prioritise the teams' work.
In all, 6.5 percent of CMP patients died in the first year of enrolment versus 9.2 percent of control patients; 13.1 percent of CMP patients and 16.6 percent of controls died in the second year. CMP was a particular benefit for patients with diabetes – their mortality rate at one year was 6.2 percent vs. 10.6 percent for controls; at two years it was 12.9 percent versus 18.2 percent.
Hospitalisations were only slightly lower overall for CMP patients than for controls, but for diabetes patients in the CMP group they were significantly lower – 21.2 percent versus 25.7 percent for controls at one year and 30.5 percent versus 39.2 percent for controls at two years.
MEDICA.de; Source: Oregon Health & Science University