Date and Time
June 24, 2009
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Among the chronic medical conditions that together consume 80% of the healthcare budget, one of the most common and expensive is coronary artery disease (CAD). The many Emergency Department (ED) visits and hospitalizations resulting from exacerbations of CAD represent approximately half of the costs of managing this condition. Nearly 15% of the 17 million Americans with established CAD (2.4 million) undergo ED evaluation for suspected acute coronary syndrome (ACS) each year. Yet, despite the 6-10 fold higher risk for death and nonfatal acute myocardial infarction (AMI) experienced by patients with established CAD, there is presently no strategy to provide them with ongoing telephone-mediated surveillance that could help them to survive a recurrent ACS. The American healthcare system provides these individuals with few alternatives to an ED visit. Early detection of deterioration in the medical status of patients with established CAD, achieved through patient-initiated telephone contact with healthcare professionals, could eliminate many unnecessary ED visits and hospitalizations and their attendant costs. However, no formal role in standard medical care presently permits nurses and other healthcare professionals to provide telephone surveillance of patients in their homes, telephone triage in the event of a change in symptoms or coordination of the subsequent care provided to such patients.

In response to this need, members of the Stanford Cardiac Rehabilitation Program have developed a comprehensive Care Management System (CMS) for patients with established CAD who experience recurrent cardiovascular symptoms. This scientifically-validated, data-driven computer-based system, links patients and their physicians by telephone, permitting a healthcare team, composed of a cardiologist and nurse care manager, to effectively coordinate the care of enrolled patients. CMS tailors the care to the level of the patient's risk of death or nonfatal myocardial infarction (MI). In pilot studies conducted in public hospitals, CMS facilitated prompt treatment of outpatients at moderate or high risk of death or nonfatal MI in a same-day clinic or ED. And, it offered reassurance and convenience for low-risk patients advised to remain at home, without detriment to their safety.

Advice provided to patients reporting symptoms to CMS staff was based on patients' reports of cardiovascular symptoms and other relevant data input to a database application following patients' enrollment into CMS. Patients' risk of death or nonfatal MI was assessed by a standardized treatment algorithm, developed by the American College of Cardiology and the American Heart Association, incorporated into an expert system within the CMS database application.

Based on the pilot study experience, CMS could safely reduce the annual frequency of ED visits, a measure of efficacy, by at least 50%, from 25% to 12.5%, resulting in reduction of ED and subsequent hospital costs reimbursed under Medicare from $5.8 B to $2.9 B annually. We project a return on investment, a measure of cost-effectiveness, of $1.10-$3.15 for each dollar of initial investment. CMS is presently operational at a private hospital in Montreal, Canada. Dissemination of CMS to additional sites could assist healthcare providers, insurors, health information technology and other entities to enhance the accessibility and cost-effectiveness of healthcare delivery for patients with established CAD.