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Deconstructing Heart Failure Disease Management

Edward H. Wagner, MD, MPH
[+] Article and Author Information

From MacColl Institute for Healthcare Innovation, Group Health Cooperative; Seattle, WA 98101-1448.


Grant Support: By grant #0347984 to the Group Health Cooperative from The Robert Wood Johnson Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Reprints: Edward H. Wagner, MD, MPH, Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448; e-mail, wagner.e@ghc.org.


Ann Intern Med. 2004;141(8):644-646. doi:10.7326/0003-4819-141-8-200410190-00015
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Frustrated by the challenges of containing costs and improving quality, many medical administrators and policymakers are turning to organized programs for patients with major chronic illnesses. These programs, generally labeled disease management, seek to provide more intensive education, monitoring, and support than may be possible in typical medical practice. Disease management nowadays is most often considered to consist of interventions delivered by a commercial entity distinct from the patient's usual source of medical care (1). Often, the programs rely on telephone contact between a distant nurse care manager and patient. Many people think of congestive heart failure (CHF), with its high rates of hospitalization and rehospitalization and increasingly effective clinical management (2), as the low-hanging fruit of disease management—a prime opportunity for early cost savings. As a result, disease management programs for CHF are proliferating. It's time to ask whether the enthusiasm is warranted.

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