Technology can help reduce death risk, costs of coronary artery disease

An intensive population management program that matches patients who have coronary artery disease to personal nurses and clinical pharmacy specialists and uses electronic medical records (EHRs), computerized disease registries, and the telephone not only reduces the risk of death but reduces healthcare costs as well, according to a new study published in the November issue of Pharmacotherapy.

Researchers from Kaiser Permanente Colorado examined healthcare expenditures in two populations of patients with coronary artery disease: a group of 628 people enrolled in the Kaiser Permanente Collaborative Cardiac Care Service (CCCS), which is a population disease management program, and 628 matched patients receiving standard care. The goal of the study was to determine whether an intensive disease management program could provide more value than usual care.

The study found that patients cared for by the CCCS experienced superior health outcomes. As compared with patients receiving usual care, enrollees in the CCCS experienced better cholesterol control, were more likely to undergo screenings and adhere to medication regimens such as those for statins, and had far fewer hospitalizations. Overall, CCCS patients had an 89% reduction in overall mortality and an 88% reduction in cardiac mortality compared with patients receiving standard care.

When the researchers compared costs, they found that healthcare expenditures for CCCS enrollees were, on average, $60 less each day, for an annual average of $21,900 per patient per year.

"The goal of the CCCS is to get patients with heart disease on the right medications and deliver needed screenings and care, so one might expect to see healthcare costs go up with the increased service," says the study's lead author, Tom Delate, PhD, of Kaiser Permanente Colorado. "However, we found the opposite effect: the CCCS was able to keep patients so healthy that they were more likely to stay out of the hospital. At the end of the day, expenditures from this major cost driver were reduced."

In the CCCS program, the majority of care is delivered over the phone by nurses and clinical pharmacy specialists who work under the direction of a physician. After hospital discharge, patients with coronary artery disease are enrolled in a 3-to-6 month rehabilitation program. Patients are assigned a personal nurse. The nurse works with the patient to implement recommendations for a healthy lifestyle. When the rehabilitation program is completed, patients are transferred to a personal clinical pharmacy specialist, who manages medications known to decrease the risk of future heart problems.

EHRs and computerized disease registries help the clinicians coordinate the care. For example, the electronic tools notify the clinical pharmacist if a patient forgets to pick up a prescription or a cholesterol test shows that a change in medication is needed. Using these electronic data, clinical pharmacists can proactively contact patients to support them in making necessary changes.