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Home > Promising Practices > Internet-Based Case Management for Secondary Prevention of Heart Disease

Internet-Based Case Management for Secondary Prevention of Heart Disease

An Evidence-Based Practice

This practice has been Archived and is no longer maintained.

Description

This program uses an internet-based program to provide risk factor management training and services to individuals with cardiovascular disease. Only 11-38% of eligible patients with cardiovascular disease participate in cardiac rehabilitation programs, despite demonstrated benefits. Offering internet-based programming allows nurse case managers to provide risk factor management training, education, and monitoring services to patients in their homes. Participants who have been diagnosed with coronary heart disease or congestive heart failure complete online education modules that include interactive, multiple choice, self-tests. Participants enter data (i.e., number of minutes of exercise, blood pressure measurements) into progress graphs which provide immediate graphic feedback showing progress over time. Participants log onto the site once a week for 30 minutes to communicate with a case manager. A registered dietitian provides feedback regarding dietary issues based upon a patient-maintained food diary.

Goal / Mission

The goal of this program is to provide risk factor management training and services to individuals with cardiovascular disease.

Impact

Intervention participants had significantly fewer cardiovascular events than patients who received usual care (4.1% vs. 15.7%, p = 0.053). Reduced hospitalization and emergency room expenses resulted in a gross cost savings of $1,418 per patient.

Results / Accomplishments

This case management system was evaluated using a randomized clinical trial of 104 patients to compare patients that used the intervention for six months to those that received usual care. Intervention participants had significantly fewer cardiovascular events than patients who received usual care (4.1% vs. 15.7%, p = 0.053). The intervention group lost significantly more weight than those receiving usual care (p = 0.003) and had significant weight loss and body mass index over the course of the intervention (p = 0.003). Differences in blood pressure, lipid levels, depression scores, minutes of exercise, and dietary habits were not statistically significant. Reduced hospitalization and emergency room expenses resulted in a gross cost savings of $1,418 per patient.

About this Promising Practice

Organization(s)
Health Management Consultants of VA, Inc.
Primary Contact
Barbara Southard, RN, MS
Health Management Consultants of VA, Inc.
2000 Kraft Drive, Suite 2001
Blacksburg, VA 24060
(540) 230-1778
bsouthard@hmcva.com
Topics
Health / Heart Disease & Stroke
Organization(s)
Health Management Consultants of VA, Inc.
Source
Health Management Consultants of VA, Inc.
Date of publication
2003
Location
Virginia
For more details
http://www.ncbi.nlm.nih.gov/pubmed/14512778?itool=...
Target Audience
Adults, Older Adults

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.