Journal of general internal medicine · 2026
Effect of Integrated Care Management Interventions on Post-hospitalization Utilization and Cost Outcomes for Adults with Multiple Chronic Conditions.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Knueven Mary Winger, Liu Yushu, Kogan Jane, Swayze Dan, Stevenson Heidi, Markwardt Sarah, Schuster James, Williams Kelly
Аннотация
BACKGROUND: A prior randomized trial assessed three care management (CM) interventions that were designed for adults at high risk of negative health outcomes following a hospital admission and implemented by a large health plan. These CM interventions positively and equivalently impacted several patient-centered outcomes over time.
OBJECTIVE: Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis).
DESIGN: Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC).
PARTICIPANTS: Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions.
INTERVENTIONS: Three CM interventions: high-tech (4-12 months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; n = 365); high-touch (4-12 months of telephonic visits; n = 335); optimal discharge planning (ODP; 2-4 weeks of telephonic visits; n = 149). All three included an initial in-person visit.
MAIN MEASURES: Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy).
KEY RESULTS: UC had access to, but rarely used, traditional health plan CM. Compared to UC members (N = 886), IC members (N = 886) had similar total cost of care (p = 0.58). IC pharmacy costs trended 93.6% higher (p = 0.06) while medical costs trended 52.5% lower (p = 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, p = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, p = 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts.
CONCLUSIONS: The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.
OBJECTIVE: Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis).
DESIGN: Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC).
PARTICIPANTS: Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions.
INTERVENTIONS: Three CM interventions: high-tech (4-12 months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; n = 365); high-touch (4-12 months of telephonic visits; n = 335); optimal discharge planning (ODP; 2-4 weeks of telephonic visits; n = 149). All three included an initial in-person visit.
MAIN MEASURES: Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy).
KEY RESULTS: UC had access to, but rarely used, traditional health plan CM. Compared to UC members (N = 886), IC members (N = 886) had similar total cost of care (p = 0.58). IC pharmacy costs trended 93.6% higher (p = 0.06) while medical costs trended 52.5% lower (p = 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, p = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, p = 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts.
CONCLUSIONS: The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.