Chronic Disease Management Initiative Reduces Hospitalizations for Ambulatory Care Sensitive Conditions among Veterans
BACKGROUND:
Hospitalization rates for ambulatory care sensitive conditions (ACSCs) are publically reported as an indicator of patients' access to effective primary care within healthcare systems. In April 2006, the VA Midwest Health Care Network (VISN 23) implemented a strategic plan to improve the management of healthcare for Veterans with chronic disease. The chronic disease management (CDM) initiative targeted three key ACSCs — diabetes, heart failure, and chronic obstructive pulmonary disease. The CDM initiative utilized a multi-faceted approach, including the following components: interdisciplinary healthcare teams focused on the care of Veterans at greatest risk; case management via telehealth; patient education and support for self-care; and the delivery of evidence-based care. This program evaluation compared average changes in hospitalization rates for all ACSCs in VISN 23 healthcare systems (n=8) with other VISNs (n=131) using FY06 (before CDM implementation) and FY10 (after implementation) data from the VA Hospital Compare website. [Each hospital and its affiliated outpatient clinics is considered a healthcare system.]
FINDINGS:
- The chronic disease management initiative in VISN 23 was associated with a significant reduction in hospitalizations for ACSCs compared with other VA healthcare systems.
- The estimated annual effect of the CDM initiative is 2.9 fewer hospital admissions per 1,000 Veterans who have an ACSC. This is nearly 10% of the average of 30.8 ACSC admissions per 1,000 Veterans in the other networks in 2010. ACSC hospitalization ratios were nearly identical in 2006 (before CDM implementation) between VISN 23 and the other VISNs.
- Further evaluation is needed to determine how various components of the initiative contributed to the observed effect and its overall cost effectiveness.
LIMITATIONS:
- Concurrent effects of differences in mortality or hospitalizations outside the VA healthcare system or other factors might not be adequately controlled in the present analysis.
AUTHOR/FUNDING INFORMATION:
This analysis was supported by, and conducted in collaboration with, VISN 23 leadership. Drs. Rector and Bloomfield, who performed the analysis, are part of HSR&D's Center for Chronic Disease Outcomes Research, Minneapolis, MN.
Rector T, Bloomfield H, Hein M, and Murphy J. Effect of a VA Chronic Disease Management Initiative on Hospitalizations for Ambulatory Care Sensitive Conditions. Federal Practitioner January 2012 Vol. 29 No. 1
