A Cost-Minimization Analysis of Nurse-Led Virtual Case Management in Late-Stage CKD

Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study

This longitudinal study aimed to evaluate a community-based and nurse-led advanced case management model centered on disease management. Participants were chronically ill patients aged 20 years and older who were highly dependent on medical care. The case management group (CMG) received nurse-led advanced case management, and the comparison group (CG) was selected by matching estimated propensity scores with the CMG. We compared the changes in medico-economic indicators between the two groups and analyzed the physical and psychological indicators of the CMG over time. The CMG comprised 51 participants, of which eight dropped out by 12 months after registration. After 1:1 propensity score matching, there were 40 participants in the CMG and CG, respectively. At 12 months after the registration, there was no significant difference between the two groups and no change in the CMG. At 24 months after the registration, the CMG’s medical and long-term care costs decreased significantly, while the CG’s costs increased. Moreover, there was a significant reduction in the number of hospital days and hospital admissions in the CMG. Our findings revealed that nurse-led advanced case management could be useful for patients with complex needs to avoid hospitalization due to exacerbations.

Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review

OBJECTIVES

This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care.

METHODS

A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.

RESULTS

This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis.

CONCLUSIONS

RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients' satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.