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Chronic Care Management: Does it work?

According to one recent study, the answer is ‘yes’.

…mortality is reduced by chronic care management, irrespective of the differences between the studies included. Furthermore, the meta-regression analysis revealed that all-cause hospitalization and the quality of life could significantly be improved by chronic care management. The study quality, the length of follow-up, and the number of CCM components do not determine the effectiveness of chronic care management.

Although chronic care management works on average, there does exist significant heterogeneity in the observed results.  Examining a number of different studies, the authors find that the magnitude of the impact of CCM depends on the study.  For instance:

All-cause hospitalization and quality of life improved significantly, yet, with substantial heterogeneity between the studies, which could not be explained by the quality of the studies, the length of follow-up, or the number of CCM components.”

What explains these findings?

One explanation is selection.  People who are more motivivated to improve their health may join a CCM.  Salutary health effects were observed even for randomized controlled trials.  The standard explanation is that care coordination help prioritize interventions and prevent adverse outcomes.  Typically, economists think that the division of labor (i.e,. specialization) improves efficiency (and in this case health outcomes).  This specialization, however, must occur in a coordinated fashion.  When building a car, each workers doesn’t work in isolation.  Similarly, although healthcare need not be more centralized–that is managed by a top-down approach–it should be more coordinated.  Whether patients themselves are able to managed their own care or whether health professionals should serve as coordinators is an open question yet to be answered.

[Likely, the answer to the question will vary by the patient’s health condition and functional status]


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