Paul L. Hebert (Department of Health Policy, Mount Sinai School of Medicine, New York, New York, USA) Jane E. Sisk (National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA)
Abstract
The positive results of several randomized controlled trials of nurse-led disease management (DM) for heart failure have led to considerable growth in the use of DM programs in such patients. However, many aspects of the protocols used in randomized trials of DM for heart failure have differed, and there are still significant gaps in our knowledge of what makes DM work and for whom. Four important unresolved issues are: (i) what components of multifaceted DM protocols for heart failure are effective; (ii) whether a face-to-face meeting with the nurse is necessary for successful DM; (iii) what type of patients benefit from DM; and (iv) who should provide and pay for nurse-led DM. Our understanding of why nurse-led DM works would be enhanced if researchers systematically described each component of the intervention, measured the patient or clinician behavior that each component was designed to modify, and reported the trial's success or failure at achieving that modification. Almost all randomized trials to-date have recruited hospitalized patients at relatively high risk of decompensation and have provided them with face-to-face contact with the DM team. More research is needed to document the effectiveness of DM protocols that use purely telephonic contact with patients, and those that recruit lower-risk patients from ambulatory settings. Finally, instead of assessing whether DM reduces costs or yields an adequate return on investment, more emphasis should be placed on cost-effectiveness research, which assesses whether DM improves patient health-related quality of life for a reasonable cost. Research along these lines will fill the gaps in our knowledge regarding the utility of DM for heart failure, and will contribute to making nurse-led DM for heart failure more effective, efficient, and commonplace.
Download Info
To download:
If you experience problems downloading a file, check if you have the
proper application to
view it first. Information about this may be contained
in the File-Format links below. In case of further problems read
the IDEAS help
file. Note that these files are not on the IDEAS
site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Find related papers by JEL classification: C - Mathematical and Quantitative Methods D - Microeconomics I - Health, Education, and Welfare Z - Other Special Topics I1 - Health, Education, and Welfare - - Health I19 - Health, Education, and Welfare - - Health - - - Other I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets