The effectiveness of chronic care management for heart failure: meta-regression analyses to explain the heterogeneity in outcomes

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Drewes, H.W. and Steuten, L.M.G. and Lemmens, L.C. and Baan, C.A. and Boshuizen, H.C. and Elissen, A.M.J. and Lemmens, K.M.M. and Meeuwissen, J.A.C. and Vrijhoef, H.J.M. (2012) The effectiveness of chronic care management for heart failure: meta-regression analyses to explain the heterogeneity in outcomes. Health services research, 47 (5). 1926 - 1959. ISSN 1475-6773

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Abstract:Objective: To support decision making on how to best redesign chronic care by studying the heterogeneity in effectiveness across chronic care management evaluations for heart failure.

Data Sources: Reviews and primary studies that evaluated chronic care management interventions.

Study design: A systematic review including meta-regression analyses to investigate three potential sources of heterogeneity in effectiveness: study quality, length of follow-up, and number of Chronic Care Model (CCM) components.

Principal findings: Our meta-analysis showed that chronic care management reduces mortality by a mean of 18% (95% CI: 0.72-0.94) and hospitalization by a mean of 18% (95% CI: 0.76-0.93) and improves quality of life by 7.14 points (95% CI: -9.55 - -4.72) on the Minnesota Living with Heart Failure questionnaire. We could not explain the considerable differences in hospitalization and quality of life across the studies.

Conclusion: Chronic care management significantly reduces mortality. Positive effects on hospitalization and quality of life were shown, however, with substantial heterogeneity in effectiveness. This heterogeneity is not explained by study quality, length of follow-up, or the number of CCM components. More attention to the development and implementation of chronic care management is needed to support informed decision making on how to best redesign chronic care.
Item Type:Article
Copyright:© 2012 Wiley
Faculty:
Management and Governance (SMG)
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Link to this item:http://purl.utwente.nl/publications/78940
Official URL:http://dx.doi.org/10.1111/j.1475-6773.2012.01396.x
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