Paper

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

BMJ 2002; 325 doi: 10.1136/bmj.325.7370.925 (Published 26 October 2002)
Cite this as: BMJ 2002;325:925
  1. Scott R Weingarten, president (sweingarten{at}cerner.com)a,
  2. James M Henning, associate directorb,
  3. Enkhe Badamgarav, clinical project leadera,
  4. Kevin Knight, research managera,
  5. Vic Hasselblad, associate research professorc,
  6. Anacleto Gano Jr, research associatea,
  7. Joshua J Ofman, enior vice president researcha
  1. aZynx Health, 9100 Wilshire Boulevard 665E, Beverly Hills, CA 90212, USA
  2. bTAP Pharmaceutical Products, Lake Forest, IL, USA
  3. cDuke Clinical Research Institute, Duke University, Durham, NC, USA
  1. Correspondence to: S Weingarten
  • Accepted 6 September 2002

Abstract

Objective: To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes.

Design: Meta-analysis.

Data sources:Computerised databases for English language articles during 1987-2001.

Study selection: 102 articles evaluating 118 disease management programmes.

Main outcome measures: Pooled effect sizes calculated with a random effects model.

Results: Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (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 improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 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 improvements in 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). Patient education, reminders, and financial incentives were all associated with 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 associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.

Footnotes

  • Funding This work was partially supported by a research grant from TAP Pharmaceutical Products

  • Competing interests SRW has been reimbursed for speaking at conferences on the topic of disease management and was a member of the NCQA Disease Management Advisory Committee. At the time of the study Zynx Health was owned by Cedars-Sinai Health System and affiliated with the UCLA School of Medicine; it is now a subsidiary of Cerner Corporation. At no time has it derived revenue from selling or providing services for disease management programmes.

  • Embedded ImageFurther details of this review appear on bmj.com and details of the studies reviewed appear on the authors' website

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