Monday, February 16, 2009

Medicare and Care Coordination - a disappointing study in JAMA

There's an interesting article in JAMA this month. It's titled, "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries"

Here's the bottom line: Care coordination programs don't seem to reduce healthcare costs among Medicare beneficiaries. This is very disappointing since you would hope that patient education would improve clinical outcomes. In this instance, nurses were contacting patients roughly twice each month. Since the patients mainly had heart failure, heart disease, and diabetes, these were patients with significant medical problems.

In my opinion, patient education that only occurs twice per month is not enough. We now have ways to automate and tailor messages. These can be sent via phone, SMS, e-mail, and a variety of other ways. When this study was designed, these resources may not have been refined like they are now. I'm sure a better study could be conducted that utilizes some of these automated technologies. After all, now we have older patients with implanted defibrillators living at home where wireless data is being captured and sent to clinicians in hospitals and offices. These types of systems can all be integrated with a robust care coordination program that can alert patients when they need to make some changes in their lifestyle before they end up being hospitalized.

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