Impact of a community-based heart failure multidisciplinary team clinic on patients’ healthcare utilization and costs in Israel. - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Jean Marc Weinstein ^1,6 Tzahit Simon-Tuval ³ Dan Kiselnik ^2,6 Zipi Hamo ^4,6 Vered Amitai ⁴ Yaron Stanovski ^7,8 Aviel Sidi ^1,6 Ghizela Kidman ⁶ Amir Sharf ⁵ Dan Greenberg ³

¹Division of Cardiology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
²Internal Medicine, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
³Dept of Health Systems Management, Guildford-Glazer Faculty of Business and Management, Ben Gurion University of the Negev, Beer Sheva, Israel
⁴Department of Nursing, Clalit Health Services, Southern Region, Israel
⁵Dept of Information and Economics, Clalit Health Services, Southern Region, Israel
⁶Heart Failure Unit, Clalit Health Services, Southern Region, Israel
⁷Internal Medicine B, Barzilai Medical Center, Israel
⁸Cardiology, Clalit Health Services, Southern Region, Israel

Introduction

A multidisciplinary team (MDT) approach in heart failure (HF) management is a key recommendation in international guidelines, to reduce mortality and HF hospitalization.

Material and methods

Using a retrospective cohort of HF patients, we investigated whether a community-based MDT in a HF unit (HFU) impacted on patients’ healthcare utilization (HCU) and costs based on claims data.

Results and discussion

Our cohort consisted of 962 patients enrolled in Clalit, the largest health plan in Israel, of whom 843 (87.6%) completed at least 12 months of follow-up and 119 (12.4%) died within 12 months following their first HFU visit. Both groups were comparable with regard to sex, socioeconomic status, Charlson comorbidity index, IHD and/or carotid artery disease, AF, obesity, and chronic pulmonary disease. Those who died within 12 months were older, had more hypertension, hyperlipidemia, diabetes, chronic renal disease and malignancy but were less likely to be smokers or to have supplementary health insurance coverage. There was a significant reduction in the total average annual HCU costs of the entire study population 12 months after the first HFU visit ($12,675 after vs. $13,188 before, p=0.014). However, while a reduction in these costs was observed among patients who completed 12 months of follow-up ($11,955 after vs. $13,112 before, p<0.001), an increase in these costs was observed among patient who died during follow-up ($17,774 after vs. $13,728 before, p=0.015). These opposite trends stem from a decrease ($3,540 after vs. $4,941 before, p<0.001) versus increase ($10,932 after vs. $6,733 before, p=0.002) in hospitalization costs of these groups, respectively, and an increase ($1,272 after vs. $928 before, p<0.001) versus decrease ($799 after vs. $1,116 before, p<0.001) in medication costs of these subgroups, respectively.

Conclusion

Intensification of therapy by a dedicated MDT significantly reduced healthcare utilization and costs, predominantly due to a decrease in hospitalizations. More widespread establishment of dedicated community-based units should be encouraged.