Interventions used in disease management programmes for patients with chronic illness---which ones work? Meta-analysis of published reports

doi:10.1136/bmj.325.7370.925

BMJ 2002;325:925 ( 26 October )

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Interventions used in disease management programmes for patients with chronic illness $---$ which ones work? Meta-analysis of published reports

Scott R Weingarten, president, ^a James M Henning, associate director, ^b Enkhe Badamgarav, clinical project leader, ^a Kevin Knight, research manager, ^a Vic Hasselblad, associate research professor, ^c Anacleto Gano Jr, research associate, ^a Joshua J Ofman, senior vice president research. ^a

^a Zynx Health, 9100 Wilshire Boulevard 665E, Beverly Hills, CA 90212, USA, ^b TAP Pharmaceutical Products, Lake Forest, IL, USA, ^c Duke Clinical Research Institute, Duke University, Durham, NC, USA

Correspondence to: S Weingarten sweingarten{at}cerner.com

Objective: To systematically evaluate the published evidenceregarding the characteristics and effectiveness of disease managementprogrammes.
Design: Meta-analysis.
Data sources: Computerised databases for English languagearticles during 1987-2001.
Study selection: 102 articles evaluating 118 disease managementprogrammes.
Main outcome measures: Pooled effect sizes calculated with a randomeffectsmodel.
Results: Patient education was the most commonly usedintervention (92/118 programmes), followed by education of healthcareproviders (47/118) and provider feedback (32/118). Most programmes(70/118) used more than one intervention. Provider education,feedback, and reminders were associated with significant improvementsin provider adherence to guidelines (effect sizes (95% confidenceintervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52(0.35 to 0.69) respectively) and with significant improvementsin patient disease control (effect sizes 0.35 (0.19 to 0.51),0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patienteducation, reminders, and financial incentives were all associatedwith improvements in patient disease control (effect sizes 0.24(0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54)respectively).
Conclusions: All studied interventions were associatedwith improvements in provider adherence to practice guidelinesand disease control. The type and number of interventions variedgreatly, and future studies should directly compare differenttypes of intervention to find the mosteffective.

What is already known on this topic
Disease management programmes have gained popularity in recent years as a means of improving the quality and efficiency of care of patients with chronic diseases

A limited number of trials have documented the effectiveness of disease management in specific situations, but uncertainty remains about its overall value and which interventions are most effective

What this study adds
Programmes using education, feedback, or reminders for healthcare providers produced significant improvements in provider adherence to care guidelines

Programmes using the provider strategies or education, reminders, or financial incentives for patients improved disease control

Further study is needed to assess the relative effectiveness of the different strategies

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