scholarly journals Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost

2018 ◽  
Vol 20 (6) ◽  
pp. e207 ◽  
Author(s):  
Ralph M Turner ◽  
Qinli Ma ◽  
Kate Lorig ◽  
Jay Greenberg ◽  
Andrea R DeVries
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Management Program ◽  
Self Management ◽  
Care Utilization ◽  
Claims Analysis

scholarly journals Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost (Preprint)

2017 ◽  
Author(s):  
Ralph M Turner ◽  
Qinli Ma ◽  
Kate Lorig ◽  
Jay Greenberg ◽  
Andrea R DeVries
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Utilization ◽  
Management Program ◽  
Self Management ◽  
Care Utilization ◽  
Control Cohort ◽  
Comorbid Conditions ◽  
Research Environment ◽  
Integrated Research

BACKGROUND An estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative. OBJECTIVE The aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost. METHODS A propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs. RESULTS The program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus–associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with −40/1000 emergency department visits vs +70/1000; P=.004 and −5780 outpatient visits per 1000 vs −290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US $2207 in the intervention cohort compared with a US $338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was –US $815 (P=.049). CONCLUSIONS Patients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US $815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results.

scholarly journals Improving Self-Management Skills Among People With Spinal Cord Injury: Protocol for a Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
W Ben Mortenson ◽  
Patricia Branco Mills ◽  
Jared Adams ◽  
Gurkaran Singh ◽  
Megan MacGillivray ◽  
...  
Keyword(s):  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Self Management ◽  
Care Utilization ◽  
Management Skills ◽  
Secondary Complications ◽  
Cord Injury

BACKGROUND Most people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury. OBJECTIVE This study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users. METHODS This study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants. RESULTS We expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization. CONCLUSIONS If the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice. CLINICALTRIAL ClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11069

scholarly journals Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis

2015 ◽  
Vol 18 (6) ◽  
pp. 412-420 ◽  
Author(s):  
Judy Quan ◽  
Alexandra K. Lee ◽  
Margaret A. Handley ◽  
Neda Ratanawongsa ◽  
Urmimala Sarkar ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Analysis ◽  
Health Care Utilization ◽  
Health Plan ◽  
Low Income ◽  
Self Management ◽  
Care Utilization ◽  
Management Support
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