An Independent Practice Association-Supported Disease Management Program: Impact on Patients with Coronary Artery Disease

Background: Disease management has been shown to improve outcomes in patients with chronic diseases such as coronary artery disease (CAD). Yet Independent Practice Associations (IPA) have expressed concern with the promise of disease management (DM) to improve patient outcomes. Managed care initiatives promote the use of case management, DM, and the use of practice guidelines. However, some physicians think that this may impinge on their autonomy. Objective: To demonstrate that integration of an independent DM company in conjunction with an IPA enhances compliance with guideline-recommended medications, reduces morbidity and improves quality of life in patients with CAD. Design: IPA physicians and an independent DM company were contracted with a health plan to provide care to patients with current or recent CAD. The DM company facilitated physician-ordered guideline implementations, provided member education, facilitated medication compliance, and collected all data, using a decision support software system. Collected data included: hospital utilization, quality of life, and reported medications and associated compliance rates. Setting: A large IPA group in the Midwest region of the US. Study Participants: Sixty-five high-risk patients with CAD who were active in the DM program as of April 2, 2002 and in the program for at least 180 days were included in the analysis. Results: The average age of the patients was 73.4 years and 54% were male. The mean duration in the DM program was 10 months (median = 7 months). For those patients (n = 54) with baseline and follow-up mental and physical quality-of-life (QOL) scores, mental QOL scores increased by 2.6% (not significant) and physical QOL scores increased by 11% (p < 0.05). In the 19 patients in the program for 12 months, a trend of reduced hospital admissions was observed. Medication compliance at baseline versus the most recent status for eligible patients was as follows: antihyperlipidemic therapy 59.7% versus 67.7%; beta-adrenoceptor antagonist therapy post-myocardial infarction 60.0% versus 66.7%; and antiplatelet therapy was maintained at 98.4%. Conclusions: In spite of the small sample size and relatively short study duration, these results indicate that an integrated DM program may enhance clinical outcomes for patients and reduce hospital admissions.