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Care coordination for patients with chronic conditions did not reduce hospital admissions or Medicare costsCommentary

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STUDY DESIGN

Design:

15 randomised controlled trials (Medicare Coordinated Care Demonstration). ClinicalTrials.gov NCT00627029.

Allocation:

concealed.*

Blinding:

unblinded.*

STUDY QUESTION

Setting:

15 various healthcare settings in the USA.

Patients:

18 402 patients (181–2657 patients per programme) covered by fee-for-service Medicare (78% aged 65–84 y; 55% women) who had ⩾1 chronic condition (eg, coronary artery disease 61%, heart failure 48%, diabetes 39%, and chronic obstructive pulmonary disease 32%). Each programme defined its own target population.

Intervention:

9427 patients were assigned to care coordination (each programme designed its own intervention) and 8975 to usual care. Although the interventions differed, most involved a care coordinator assigned to each patient who assessed patient needs, developed patient care plans, educated patients to improve adherence, and improved care coordination.

Outcomes:

hospital admissions, Medicare expenditures (including negotiated programme fees of mean $235/member per mo but not including prescriptions drugs), and quality-of-care measures. A p …

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