RAMB - Maio / Junho 2016

hronic

case

management

: C

linical

governance

with

cost

reductions

ssoc

ras

2016; 62(3):231-235

231

ORIGINAL ARTICLE

Chronic case management: Clinical governance with cost reductions

lide

bardellotto

ariano

osta

*, A

driano

yeda

Medical Audit, Fundação Unimed. Cardiologist by Pontifícia Universidade Católica do Paraná (PUC-PR). Executive MBA in Health Administration by Instituto Superior de Administração e Economia/

Fundação Getulio Vargas (ISAE/FGV), Curitiba, PR, Brazil

Occupational Health Coordinator, PUC-PR. Oncologist, Universidade Federal do Paraná (UFPR). Executive MBA in Health Administration by ISAE/FGV, Curitiba, PR, Brazil

ummary

Study conducted at the Executive

Master Business Administration (MBA)

in Health Program, Group 1/12, Lato

sensu graduate degree – Specialization

level, FGV Management Program,

Instituição Superior de Administração

e Economia/Fundação Getulio Vargas,

Curitiba, PR, Brazil

Article received:

9/8/2014

Accepted for publication:

9/9/2014

*Correspondence:

Address: Rua José Loureiro, 195,

12º andar, Centro,

Curitiba, PR – Brasil

Postal code: 80010-000

Phone: +55 41 3330-6110

elide@onda.com.br http://dx.doi.org/10.1590/1806-9282.62.03.231

Introduction:

With increasing global impact of chronic degenerative non-com-

municable diseases (CDNCD), multidisciplinary chronic disease management care

programs (CDMCP) come as a solution to improve the quality of patients care.

Method:

We conducted a cross-sectional epidemiologic prospective cohort study

with data comparing a group of patients monitored by a CDMCP with subjects

without CDMCP care, from 2010 to 2012. The patients monitored in this pro-

gram were selected because they presented CDNCD with frequent hospitaliza-

tion and/or emergency care in the year prior to study selection. Also, the patients

could be referred to the program by their physicians and/or other programs such

as HomeCare or family medicine. All costs related to the program were includ-

ed and compared with the costs of users with the same epidemiological profile

who opted for not participating in the CDMCP.

Results:

We analyzed data from 1,256 cases, including 639 (51%) men and 617

(49%) women. The mean age was 56.99 years and 73% were older than 50 years.

There was a prevalence of 34% (428) cases with ischemic heart disease (myocar-

dial infarction and stroke) and 17% (210) with neoplasms. The cases studied

showed a reduction of 79% in the number of days of hospitalization compared

with the cases without CDMCP monitoring. The average reduction of total costs

(hospitalizations, emergency room visits and/or disease complications) was

31.94%, with average reduction of 8.36% in monthly costs.

Conclusion:

Multidisciplinary monitoring carried out by CDNCD patient man-

agement programs can reduce hospitalizations, emergency room visits and com-

plications, positively impacting the costs with health care.

Keywords:

chronic disease, health management, health care costs, clinical gov-

ernance.

ntroduction

Case management

By the mid 1980s, North American hospitals began fac-

ing financial constraints.

In the same context, in Brazil

since the beginning of the 1990s, it became a challenge

for managers of health plans to offer a quality service to

their beneficiaries, seeking to maintain financial sustain-

ability.

The provision of health care is based on three guide-

lines: management, measurement and qualification.

Man-

agement includes primary care, clinical guidelines, pa-

thology management, case management, clinical risk

management, hospitalization management, waiting list,

the customer service center, and audits.

Case management, specifically, is a cooperative pro-

cess that is undertaken between the case manager, their

multidisciplinary team and the client, in order to plan,

monitor and evaluate options and services, according to

the health needs of the patient.

It is a system of vertical

and horizontal integration. Its main work instrument is

communication with the user.

Chronic degenerative and non-communicable diseases (CDNCD)

In recent decades, Brazil has presented important trans-

formations in its pattern of mortality and morbidity due

to changes in demographic, epidemiological and nutri-

tional profiles. This phenomenon also accompanied the

growth of the elderly population and reduction in child