Coaching Patients Saves Lives and Money

Journal article


Joshua Byrnes, Thomas Elliott, Margarite Vale, Michael Jelinek and Paul Scuffham. (2018). Coaching Patients Saves Lives and Money. American Journal of Medicine. 131(4), pp. 415-422. https://doi.org/10.1016/j.amjmed.2017.10.019
AuthorsJoshua Byrnes, Thomas Elliott, Margarite Vale, Michael Jelinek and Paul Scuffham
Abstract

Background
The Coaching On Achieving Cardiovascular Health (COACH) Program has been proven to improve biomedical and lifestyle cardiovascular disease (CVD) risk factors. The objective of this study was to evaluate the long-term impact of The COACH Program on overall survival, hospital utilization, and costs from the perspective of a private health insurer (payor), in patients with CVD.

Methods
A prospective parallel-group case-control study design with controls randomly matched to patients based on propensity score. There were 512 participants with CVD engaged in a structured disease management program of 6 months duration (The COACH Program) who were matched to 512 patients with CVD who were allocated to the control group. The independent variables that estimated the propensity score were preprogram hospital admissions, age, and sex. The primary outcome was overall survival with secondary outcomes, including hospital utilization and cost incurred by the private health insurer. Mean follow-up was 6.35 years. Difference in overall survival between the 2 groups was estimated using a Cox proportional hazard ratio (HR) with difference in total cost estimated using a generalized linear model.

Results
The COACH Program achieved a significant reduction in overall mortality (HR 0.70; 95% confidence interval [CI], 0.53-0.93; P = .014). There was an apparent dose-response effect: those who received up to 3 coaching sessions had no decrease in mortality (HR 1.02; 95% CI, 0.69-1.49; P = .926); those who received 4 or more coaching sessions had a substantial decrease in mortality (HR 0.58; 95% CI, 0.42-0.81; P = .001). Total cost to the health insurer was substantially lower in the intervention group ($12,707 per person lower; P = .078). The reduction in total cost was significantly greater in those who received 4 or more sessions ($19,418 per person; P = .006) and in males ($18,947 per person; P = .029).

Conclusions
Those enrolled in The COACH program achieved a statistically significant decrease in overall mortality compared with usual care at 6.35 years. A substantive reduction in hospital costs was also observed among those who received The COACH program compared with those who did not, particularly in those who received 4 or more sessions and in males.

Keywordscardiovascular disease; cost-benefit analysis; disease management; evidence-practice gaps; health coaching
Year2018
JournalAmerican Journal of Medicine
Journal citation131 (4), pp. 415-422
PublisherElsevier Inc.
ISSN0002-9343
Digital Object Identifier (DOI)https://doi.org/10.1016/j.amjmed.2017.10.019
Scopus EID2-s2.0-85037585127
Publisher's version
File Access Level
Controlled
Publication process dates
Deposited10 May 2021
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