Medical Care

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Medical Care:
doi: 10.1097/MLR.0b013e3181e419c9
Original Article

Disease Management 360o: A Scorecard Approach to Evaluating TRICARE's Programs for Asthma, Congestive Heart Failure, and Diabetes

Yang, Wenya MA, MPA*; Dall, Timothy M. MS*; Zhang, Yiduo PhD*; Hogan, Paul F. MS*; Arday, David R. MD, MPH†; Gantt, Cynthia J. NC, USN, C-FNP, PhD‡

Supplemental Author Material
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Objective: To assess the effect of TRICARE's asthma, congestive heart failure, and diabetes disease management programs using a scorecard approach.

Evaluation Measures: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard.

Research Design: Actual outcomes for program participants were compared with outcomes predicted in the absence of disease management. The predictive equations were established from regression models based on historical control groups (n = 39,217). Z scores were calculated for the humanistic measures obtained through a mailed survey.

Data Collection Methods: Administrative records containing medical claims, patient demographics and characteristics, and program participation status were linked using an encrypted patient identifier (n = 57,489). The study time frame is 1 year prior to program inception through 2 years afterward (October 2005–September 2008). A historical control group was identified with the baseline year starting October 2003 and a 1-year follow-up period starting October 2004. A survey was administered to a subset of participants 6 months after baseline assessment (39% response rate).

Results: Within the observation window—24 months for asthma and congestive heart failure, and 15 months for the diabetes program—we observed modest reductions in hospital days and healthcare cost for all 3 programs and reductions in emergency visits for 2 programs. Most clinical outcomes moved in the direction anticipated.

Conclusions: The scorecard provided a useful tool to track performance of 3 regional contractors for each of 3 diseases and over time.

© 2010 Lippincott Williams & Wilkins, Inc.


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