Stanford study highlights cost-effective method of lowering heart dis...(iding tobacco. The study grew out of...),Health

The study grew out of an ongoing, federally funded project involving Stanford and nearby San Mateo County aimed at exploring a broad range of services to lower heart disease risks among a culturally diverse, low-income population.

For the case-management study, researchers followed 341 patients who were randomly assigned to receive either primary care alone or primary care augmented by case-management visits over a 17-month period.

The case-management visits took place at four clinics operated by San Mateo Medical Center, the county's public hospital and clinic system, and were supplemented with phone calls. Case managers emphasized behavior changes, such as better eating and more exercise, and helped ensure that patients used prescribed medications properly. Patients were involved in their own care through self-monitoring and reporting.

The patients had an average of 14 hours of contact with the case managers during the study period, usually in the form of face-to-face visits that lasted 40 to 60 minutes. At each visit, the patient and case manager reviewed the patient's progress on lifestyle and medication goals, and developed a plan for the coming weeks. Dictated notes about each visit were made available to the patient's primary-care physician.

At the study's outset, Stafford said, the patient population had a 10-15 percent risk of suffering a heart attack or severe heart disease within the next 10 years. After the study, the patients who participated in case-management visits lowered their risks by 1.6 percent - roughly a 10 percent reduction.

The study estimated the overall cost of the case-management visits at about $1,250 per patient, or about the price of six regular office visits to a primary-care physician. Stafford said that's a relatively small outlay to reduce the risk of a heart attack, which often entails hospital costs of more than $40,000.

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