Research Article
The Effectiveness of Chronic Care Management for Heart Failure: Meta-Regression Analyses to Explain the Heterogeneity in Outcomes
Hanneke W. Drewes,
Lotte M. G. Steuten,
Lidwien C. Lemmens,
Caroline A. Baan,
Hendriek C. Boshuizen,
Arianne M. J. Elissen,
Karin M. M. Lemmens,
Jolanda A. C. Meeuwissen,
Hubertus J. M. Vrijhoef,
Corresponding Author
Hanneke W. Drewes
Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg
Address correspondence to Hanneke W. Drewes, M.Sc., Scientific Centre for Care and Welfare (Tranzo), Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; and National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; e-mail: [email protected]Search for more papers by this authorLotte M. G. Steuten
Health Technology and Services Research, University of Twente, Enschede
Search for more papers by this authorLidwien C. Lemmens
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorCaroline A. Baan
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorHendriek C. Boshuizen
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorArianne M. J. Elissen
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht
Search for more papers by this authorKarin M. M. Lemmens
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam
Search for more papers by this authorJolanda A. C. Meeuwissen
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Search for more papers by this authorHubertus J. M. Vrijhoef
Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht
Search for more papers by this authorHanneke W. Drewes,
Lotte M. G. Steuten,
Lidwien C. Lemmens,
Caroline A. Baan,
Hendriek C. Boshuizen,
Arianne M. J. Elissen,
Karin M. M. Lemmens,
Jolanda A. C. Meeuwissen,
Hubertus J. M. Vrijhoef,
Corresponding Author
Hanneke W. Drewes
Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg
Address correspondence to Hanneke W. Drewes, M.Sc., Scientific Centre for Care and Welfare (Tranzo), Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; and National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; e-mail: [email protected]Search for more papers by this authorLotte M. G. Steuten
Health Technology and Services Research, University of Twente, Enschede
Search for more papers by this authorLidwien C. Lemmens
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorCaroline A. Baan
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorHendriek C. Boshuizen
National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven
Search for more papers by this authorArianne M. J. Elissen
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht
Search for more papers by this authorKarin M. M. Lemmens
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam
Search for more papers by this authorJolanda A. C. Meeuwissen
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Search for more papers by this authorHubertus J. M. Vrijhoef
Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht
Search for more papers by this authorAbstract
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 components.
Principal Findings
Our meta-analysis showed that chronic care management reduces mortality by a mean of 18 percent (95 percent CI: 0.72–0.94) and hospitalization by a mean of 18 percent (95 percent CI: 0.76–0.93) and improves quality of life by 7.14 points (95 percent CI: −9.55 to −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 chronic care model 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.
Supporting Information
| Filename | Description |
|---|---|
| hesr1396-sup-0001-Appendix1.docWord document, 81.5 KB | Appendix SA1: Author Matrix. |
| hesr1396-sup-0002-Appendix2.docWord document, 71 KB | Appendix S1: Overview of Systematic Reviews Included. |
| hesr1396-sup-0003-Appendix3.docWord document, 129.5 KB | Appendix S2: Detailed Description of Primary Studies Included. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Citing Literature
