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dc.contributor.authorByrnes, Joshua
dc.contributor.authorElliott, Thomas
dc.contributor.authorVale, Margarite J
dc.contributor.authorJelinek, Michael V
dc.contributor.authorScuffham, Paul
dc.date.accessioned2019-06-07T01:30:45Z
dc.date.available2019-06-07T01:30:45Z
dc.date.issued2018
dc.identifier.issn0002-9343
dc.identifier.doi10.1016/j.amjmed.2017.10.019
dc.identifier.urihttp://hdl.handle.net/10072/370507
dc.description.abstractBACKGROUND: 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 followup 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.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherElsevier
dc.publisher.placeUnited States
dc.relation.ispartofpagefrom415
dc.relation.ispartofpageto421
dc.relation.ispartofissue4
dc.relation.ispartofjournalAmerican Journal of Medicine
dc.relation.ispartofvolume131
dc.subject.fieldofresearchMedical and Health Sciences not elsewhere classified
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode119999
dc.subject.fieldofresearchcode11
dc.titleCoaching Patients Saves Lives and Money
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.facultyGriffith Health, School of Medicine
gro.description.notepublicThis publication has been entered into Griffith Research Online as an Advanced Online Version.
gro.hasfulltextNo Full Text
gro.griffith.authorScuffham, Paul A.
gro.griffith.authorByrnes, Joshua M.


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