Proactive care saves lives of seniors, s...(and second years than among the 2288 pat...)

Seven Intermountain clinics served the CMP patients and six the control group patients. Each CMP patient was matched with two control patients based on age, hospitalization records, comorbidity scores, gender, and specific chronic illnesses. The average age of all patients was 76. Three quarters of them had two or more chronic illnesses. Just over 64 percent were females.

In all, 6.5 percent of CMP patients died in the first year of enrollment versus 9.2 percent of control patients; 13.1 percent of CMP patients and 16.6 percent of controls died in the second year. CMP was a particular benefit for patients with diabetes who constituted 48.7 percent of all patients in the study and had a significantly higher number of comorbidities. Their mortality rate at one year was 6.2 percent vs. 10.6 percent for controls; at two years it was 12.9 percent vs. 18.2 percent.

Hospitalizations were only slightly lower overall for CMP patients than for controls, but for diabetes patients in the CMP group they were significantly lower 21.2 percent versus 25.7 percent for controls at one year and 30.5 percent versus 39.2 percent for controls at two years.

Intermountain Healthcare has a long history of innovative use of computers in improving healthcare. At the CMP clinics, computer tools were combined with a registered nurse who received extra training. Physicians referred patients with complex conditions to the nurse care manager who completed a patient assessment focused on self-efficacy, knowledge, readiness to change and patient-directed goal setting. The care manager then created with the patient a detailed care plan supported by specialized computer tools, including structured protocols and guidelines for various conditions and diseases, a care management tracking (CMT) database and detailed electronic patient worksheet. The care manager suggested medicat
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