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C

hronic

case

management

: C

linical

governance

with

cost

reductions

R

ev

A

ssoc

M

ed

B

ras

2016; 62(3):231-235

233

It is important to emphasize that patients remained

under the care of their assisting doctors, who took the fi-

nal decisions about clinical and therapeutic management.

The managing physician of the program was responsible

for defining the frequency of user assessment, according

to the morbidities and the risk of complications of the

existing CDNCD. There was no interference in the fre-

quency of consultations defined by the attending physi-

cian. Therefore, the CDMCP studied was limited to in-

formational and educational actions.

Economic analysis

To analyze the economic impact of the program, the actu-

al total costs of health care in the group monitored in the

programwere compared with those of the group that chose

not to be monitored. The total costs included medical and

non-medical consultations (including the CDMCP), hos-

pitalization, complementary examinations, surgeries, che-

motherapy, radiation therapy and hemodynamic proce-

dures. The costs were recorded in national currency (BRL)

in the period analyzed. The absolute data (non-itemized

total direct costs) were made available through account-

ing reports provided by the CDMCP. Indirect costs will be

analyzed in another text.

Statistical analysis

Qualitative data (gender, age, ICD-10) were described us-

ing frequencies and percentages. Quantitative data from

the costs were described using maximums, minimums,

arithmetic means, standard deviations (SD) and 95% con-

fidence intervals (95CI) with significance at p<0.05. The

data was tabulated and analyzed using spreadsheets and

charts (Excel

®

format from the Office 2007

®

system for

Windows

®

) and these remained at the disposal of profes-

sionals from the program and HP management.

R

esults

Data from 2,107 cases were selected (1,018 women and

1,089 men, with an average age of 56 years), and these

were divided into two groups: The 1,256 users who opt-

ed for the program (59.61%) and the 851 patients who

chose not to participate (40.38%) (SD±286.37, 95CI

1041.27-1065.73). The main characteristics are described

in Table 1.

Six hundred and thirty-nine of the 1,256 study par-

ticipants (51%) were male and 617 (49%) female, with gen-

der distribution similarity (SD±15.55; 95CI 627.14-628.26).

Mean age was 56.9 (SD±17.65; 95CI 56.01-57.96) years,

ranging from one to 95 years; 73% of subjects were older

than 50 years.

Three-hundred and seventy-nine of the 851 non-par-

ticipants (44.53%) were female, and 472 (55.46%) male

(SD±65.76; 95CI 421.08-429.92). Their mean age was 56.2

(SD±17.58; 95CI 55.46-56.97), ranging from one to 103

years; 73.27% of cases were older than 50 years.

In the CDMCP group, there were 428 (34%) cases of

ischemic heart diseases (coronary atherosclerotic disease

and stroke), 210 (17%) neoplasms, 151 (12%) musculo-

skeletal disorders and 79 (6%) metabolic diseases (diabe-

tes, dyslipidemia, thyroid diseases) and the remainder was

distributed within the total pathologies classified accord-

ing to the ICD-10. In the non-CDMCP group there were

449 (52.83%) cases of cardiovascular diseases and 80

(9.43%) presented neoplasms.

Sixty-three percent of the participants (786) in the

CDMCP were classified as holders of health insurance

plans and 37% (470) were classified as dependents.

In the CDMCP group, users had 1946 consultations

in 290 months of monitoring, 690 (35.45%) of which were

return consultations in the program itself, with an aver-

age of 57.5 per month (SD±24.93; 95CI 56.12-58.87). The

majority of returns referred to cases of cerebrovascular

diseases and/or neoplasms. Of these, 40.35% presented

bi-monthly consultations with their attending physicians

(consultations ranging from weekly to half-yearly).

The sum of the total number of days of hospitaliza-

tion in the CDMCP group was 230 days compared with

1,097 days in the non-CDMCP group (SD±613.62, 95CI

TABLE 1

 Clinical and demographic characteristics of the CDMCP and non-CDMCP groups.

Characteristics

CDMCP group Non-CDMCP group

(n=1256)

(n=851)

Variance Mean Standard deviation (±) 95CI

Women

639

379

33800

509.00 183.848

11.2936

Men

617

472

10512.5 544.50 102.530

6.0896

Age (means)

56.9

56.2

0.29645 56.6

0.544

0.0300

ICD (chapters)

(I) Cardiovascular diseases

428

449

220.5

438.50 14.849

0.9828

(C) Neoplasms

210

80

8450

145.00 91.924

10.5798

ICD: International Classification of Diseases; CDMCP: chronic disease management care programs.