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.