title: Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease 15-Site Randomized Trial of Coordinated Care in Medicare FFS Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty. A randomized study of a multifactorial programme. Impacts of a Disease Management Program for Dually Eligible Beneficiaries Changes in functional health status of older women with heart disease: evaluation of a program based on self-regulation. Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention Long-term effects of lifestyle behavior change in coronary artery disease: effects on recurrent coronary events after percutaneous coronary intervention. Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study. Can A Disease Self-Management Program Reduce Health Care Costs?: The Case of Older Women With Heart Disease Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial. Effects of a Problem-Based Learning Rehabilitation Programme on Quality of Life in Patients with Coronary Artery Disease Five year follow up of patients at high cardiovascular risk who took part in randomised controlled trial of health promotion Clinical trial of an Internet-based case management system for secondary prevention of heart disease. Heart Disease Management by Women: Does Intervention Format Matter? Cost effectiveness of personal health education in primary care for people with angina in the greater Belfast area of Northern Ireland. Impact of self-management education on the functional health status of older adults with heart disease. [Efficacy of an educational preventive technology in patients with stable angina in ambulatory conditions]. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.
abstract: Objective The aim of this study was to evaluate the impact of a home based intervention program ( HBIP ) on health related quality of life ( HRQoL )  after coronary artery bypass grafting ( CABG ) .  To strengthen the clinical interpretation , HRQoL data were compared to the general population . Methods In a r and omised controlled trial ( RCT ) , a total of 185 CABG patients ( 93 vs 92 ) completed the study . The intervention group received a HBIP 2 and 4 weeks after surgery .  HRQoL was measured by the Seattle Angina Question naire ( SAQ ) and the Short Form 36 ( SF-36 ) in both patient groups before surgery , at 6 weeks and 6 months after surgery . Results Significant improvements were found in both groups for the majority of subscales of HRQoL at 6-week and 6-month follow-up . However , these improvements did not differ significantly between the groups . Compared to the general population , significant differences ( P < 0.05 ) were found for the SF-36 subscales : role physical , role emotional and bodily pain . Conclusions HRQoL after CABG improved markedly over time , but no significant or clinical ly important differences were found when compared with controls . Thus , work to further develop and test the effect of a HBIP on HRQoL in patients undergoing rehabilitation following CABG is warranted Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of Medicare beneficiaries in fee-for-service ( FFS ) who had chronic illnesses and volunteered to participate in 15 care coordination programs were r and omized to treatment or control status .  Nurses provided patient education ( mostly by telephone ) to improve adherence and ability to communicate with physicians . Patients were contacted an average of two times per month . The findings after 2 years are not encouraging . Few programs improved patient behaviors , health , or quality of care . The treatment group had significantly fewer hospitalizations in only one program ; no program reduced gross or net expenditures . However , effects may be observed when 4 years of followup are available and sample sizes increase AIMS In a multifactorial lifestyle behaviour programme , of 2 years duration , to study the maintenance of achieved behaviour and risk factor-related changes . METHODS AND RESULTS Out of a consecutive population of 151 patients treated with percutaneous transluminal angioplasty under 65 years of age , 87 were r and omly allocated to an intervention group ( n=46 ) or to a control group ( n=41 ) . The programme started with a 4 week residential stay , which was focused on health education and the achievement of  behaviour change .  During the first year of follow-up , a maintenance programme included regular contacts with a nurse , while no further rehabilitative efforts were offered during the second year . One patient died ( control ) . During the second year the proportion of hospitalized patients was lower in the intervention group ( 4 % vs 20%;P<0.05 ) . Patients in the intervention group improved several lifestyle dependent behaviours : diet ( index at 0 , 12 and 24 months ) : 10.5+/-3 . 4 , 12.9+/-2.5 and 12.4+/-2.6 in the intervention group ( I ) vs 10 . 1+/-3.2 , 10.7+/-3.0 and 11.8+/-3.2 in the control group (C);P<0.05 , exercise sessions per week : 2.5+/-2.3 , 4.5+/-1.9 and 4.4+/-2.1 ( I ) vs 3.1+/-2.2 , 3.5+/-2.3 and 3.7+/-2.7 (C);P<0.05 , and smoking ; 18 % , 6 % and 9 % ( I ) vs 12 % , 21 % and 18 % (C);P<0.05 . This corresponded to improvement in exercise capacity ( 0 , 12 and 24 months ) : 156+/-42 , 174+/-49 and 165+/-47 W ( I ) vs 164+/-40 , 163+/-49 and 156+/-48 watts (C);P<0.05 . There were no significant differences between the two groups with regard to serum cholesterol levels at 0 and 24 months : 5 . 4+/-0.8 and 5.2+/-0.9 mmol . l(-1)(I ) vs 5.4+/-1.0 and 4.9+/-0.9 mmol . l(-1)(C ) ; ns , low density lipoprotein cholesterol level : 3.6+/-0.8 and 3.4+/-0.8 mmol . l(-1)(I ) vs 3.7+/-0.9 and 3.3+/-0.7 mmol . l(-1)(C ) ; ns , triglyceride level : 2.2+/-1.6 and 1.8+/-1.3 mmol . l(-1)(I ) vs 2.2+/-1.4 and 1.6+/-0.6 mmol . l(-1)(C ) ; ns , body mass index ( 0 , 12 and 24 months ) : 27.5+/-4.5 , 27.0+/-4.3 and 27.4+/- 4.5 kg . m(-2)(I ) vs 26.8+/-2.8 , 26.9+/-2.7 and 26.9+/- 3.2 kg . m(-2)(C ) ; ns , waist/hip ratio or blood pressure . The two groups did not differ in quality of life , or psychological factors . Return to work after 12 and 24 months was 74 % and 78 % ( I ) vs 68 % and 61 % ( C ) ; ns . CONCLUSION This rehabilitation programme influenced important lifestyle behaviour and reduced some , but not all , important risk The LifeMasters Supported SelfCare demonstration program provides disease management ( DM ) services to Florida Medicare beneficiaries who are also enrolled in Medicaid and have congestive heart failure ( CHF ) , diabetes , or coronary artery disease ( CAD ) . The population -based program provides primarily telephonic patient education and monitoring services . Findings from the r and omized , intent-to-treat design over the first 18 months of operations show virtually no overall impacts on hospital or emergency room ( ER ) use , Medicare expenditures , quality of care , or prescription drug use for the 33,000 enrollees . However , for beneficiaries with CHF who resided in high-cost South Florida counties , the program reduced Medicare expenditures by 9.6 percent OBJECTIVES This study involving 570 women aged 60 years or older with heart disease , assessed the effects of a disease management program on physical functioning , symptom experience , and psychosocial status . METHODS Women were r and omly assigned to control or program groups . Six to eight women met weekly with a health educator and peer leader over 4 weeks to learn self-regulation skills with physical activity as the focus . Evaluative data were collected through telephone interviews , physical assessment s , and medical records at baseline and 4 and 12 months post baseline . RESULTS At 12 months , compared with controls , program women were less symptomatic ( p < .01 ) , scored better on the physical dimension of the Sickness Impact Profile ( SIP ; p < 0.05 ) , had improved ambulation as measured by the 6-minute walk ( p < 0.01 ) , and lost more body weight ( p < .001 ) . No differences related to psychosocial factors as measured by the SIP were noted . CONCLUSION A self-regulation-based program that was provided to older women with heart disease and that focused on physical activity and disease management problems salient to them , improved their physical functioning and symptom experience . Psychosocial benefit was not evident and may be a result of measurement error or due to insufficient program time spent on psychosocial aspects of functioning Abstract Objective : To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities . Design : R and omised controlled trial of personal health education given every four months . Setting : 18 general practice s in the greater Belfast area . Subjects : 688 patients aged less than 75 years and known to have had angina for at least six months ; 342 r and omised to receive education and 346 to no education .  Main outcome measures : Restriction of everyday activities , dietary habit , smoking habit , frequency of physical exercise ; blood pressure , body mass index , and serum total cholesterol concentration at entry to trial and after two years . Results : 317 in the intervention group and 300 in the control group completed the trial . At the two year review more of the intervention group ( 140 , 44 % ) reported taking daily physical exercise than the control group ( 70 , 24 % ) . The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity . No significant differences were found between the groups in smoking habit , systolic or diastolic blood pressure , cholesterol concentration , or body mass index . Conclusion : Despite having no significant effect on objective cardiovascular risk factors , personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities Background Providing information is an important part of st and ard care and treatment for acute myocardial infa rct ion in patients . Evidence exists indicating that acute myocardial infa rct ion patients experience an information gap in the period immediately after discharge from the hospital . The aim of this study was to assess the short-term effects of a nurse-led telephone follow-up intervention to provide information and support to patients with acute myocardial infa rct ion after their discharge from hospital . Design and method A prospect i ve r and omized , controlled trial with a 6-month follow-up was conducted . A total of 288 patients were allocated to either an intervention group ( n = 156 ) or a control group ( n = 132 ) . The latter received routine post-discharge care . The primary endpoint measured at 3 and 6 months after discharge was the health-related quality of life using the 36-item Short Form Health Survey . Secondary endpoints included smoking and exercise habits . Results In both groups , health-related quality of life improved significantly over time on most subscales . A statistically significant difference in favour of the intervention group was found on the 36-item Short Form Health Survey Physical Health Component Summary Scale ( P=0.034 ) after 6 months . No difference was found between the groups on the Mental Health Component Summary Scale . We found a significant difference with respect to frequency of physical activity in favour of the intervention group after 6 months ( P=0.004 ) . More participants in the intervention group than the control group had ceased smoking at the 6-month follow-up ( P=0.055 ) . Conclusion A nurse-led systematic telephone follow-up intervention significantly improved the physical dimension of health-related quality of life in patients in the intervention group compared with usual care patients . Participation in this intervention also seemed to promote health behaviour change in patients after acute myocardial infa rct ion This study evaluated the effects of a behaviorally oriented cardiac rehabilitation and secondary prevention program on lifestyle changes and on coronary recurrence rates .  Patients recently treated with percutaneous coronary intervention ( PCI ) were r and omized to an intervention with an aggressive focus on lifestyle changes ( smoking , diet , exercise , and stress ; n=46 ) or to a st and ard-care control group ( n=42 ) . Results showed that the intervention group had significantly larger overall lifestyle changes than the control group after 12 , 24 , 36 , and 60 months . The intervention group had significantly lower rates of all coronary events ( acute myocardial infa rct ion , coronary artery bypass graft , PCI , cardiac death ; 30.4 % vs. 53.7 % ) , and of cardiovascular mortality ( 2.2 % vs. 14.6 % ) . The need for future large-scale and long-term evaluations of lifestyle-oriented secondary prevention interventions of this kind is emphasized A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty ( PTCA ) were r and omly assigned to either an intervention or a control group . Subjects in the intervention group participated in a comprehensive behaviorally oriented program aim ed at achieving significant long-term changes in risk factor-related lifestyle behavior . Assessment s of lifestyle behaviors , psychological factors , biological risk factors , and rehabilitation as well as secondary prevention endpoints were carried out , at inclusion and after 12 months . Results showed that the intervention patients , as compared with controls , improved significantly on measures assessing smoking , exercise , and diet habits . These self-rated changes were confirmed by weight reductions and improved exercise capacity , as well as by between-group differences in sub clinical chest pain during an exercise test . However , few effects were found on the different psychological variables , as well as on morbidity or return to work Background . There is increasing interest in the potential for chronic disease self-management interventions to provide health benefits while reducing health care costs . Objectives . To assess the impact of a heart disease management program on use of hospital services ; to estimate associated hospital cost savings ; and to compare potential cost savings with the cost of delivering the program . Research Design . R and omized , controlled study design . Data were collected from hospital billing records during a 36 month period . Multivariate models were used to compare health care use with cost between treatment and control groups . Estimated differences were then compared with the program costs to determine cost-effectiveness . Subjects . Participants were recruited from 6 hospital sites . Screening criteria included : female , 60 years or older , diagnosed cardiac disease , and seen by a physician approximately every 6 months . The study included 233 women in the intervention group and 219 in the control group . The “ Women Take PRIDE ” program utilizes a self-regulation process for addressing a problematic area of the heart regimen recommended by each woman ’s physician . It is tailored to the unique needs of older women . Measures . Hospital admissions , in-patient days , emergency department visits . Results . Program participants experienced 46 % fewer in-patient days ( P < 0.05 ) and 49 % lower in-patient costs ( P < 0.10 ) than women in the control group . No significant differences in emergency department utilization were found . Hospital cost savings exceeded program costs by a ratio of nearly 5-to-1 . Conclusions . A heart disease self-management program can reduce health care utilization and potentially yield monetary benefits to a health plan AIMS An earlier combined proactive and reactive telephone follow-up intervention for acute myocardial infa rct ion patients after discharge from hospital showed positive effects after six months . The aim of the present study was to assess whether the intervention has long-term effects up to 18 months after discharge . DESIGN A prospect i ve r and omised controlled trial with 18 months follow-up . METHOD The trial was conducted with 288 patients allocated to a telephone follow-up intervention group ( n = 156 ) or control group ( n = 132 ) . The primary endpoint was health-related quality of life using the SF-36 . Secondary endpoints included smoking and exercise habits , return to work and rehospitalisation due to chest pain . RESULTS There were significant improvements over time on most dimensions of health-related quality of life in both the intervention and control group to US norm population levels on most SF-36 dimensions and summary scores . The intervention group showed no overall significant improvement beyond six months in the physical or mental summary scores , but there was a significant effect for those aged 70 or above . Although there was a promising effect for rehospitalisation due to chest pain , no significant differences were found between the groups on the secondary endpoints after six months . CONCLUSION This study demonstrated that despite positive short-term effects at six months , the telephone follow-up intervention had no long-term effects on health-related quality of life or secondary endpoints . However , the potential for improvement beyond six months was less than anticipated reflecting a reduced morbidity among acute myocardial infa rct ion patients . RELEVANCE TO CLINICAL PRACTICE Telephone follow-up after discharge from hospital is an easy implementable follow-up intervention enabling individualised provision of information and support in a time often experienced as stressful by patients . Our study indicates that six months is an adequate support period . Despite positive results six months after discharge no significant added long-term effects of telephone follow-up , compared to usual care were found in this study Background : The aim of cardiac rehabilitation ( CR ) is not only physical improvement but also increased quality of life ( QoL ) . A CR programme based upon problem based learning ( PBL ) philosophy was developed , to achieve and apply new knowledge related to coronary artery disease ( CAD ) . The aim of this paper was to evaluate the impact of the PBL programme on QoL. Methods : 207 consecutive patients < 70 years of age with a recent event of CAD were r and omised to a  PBL group ( n = 104 ) or a control group ( n = 103 ) . In addition to st and ard treatment , the PBL patients participated in 13 group sessions during 1 year , where individual learning needs and behavioural changes were focused upon . QoL was measured by the Ladder of Life , Self-Rated Health ( SRH ) , SF 36 , and Cardiac Health Profile ( CHP ) . Results : Significant differences between the groups , favouring the PBL patients , were found by global instruments : more optimistic expectations of the future QoL and a better general condition . No differences were found by SRH , SF 36 or subscales of CHP , but QoL increased in both groups during the year . Conclusions : The main outcome was that QoL improved in both groups with some effects favouring the PBL programme Health promotion programmes for patients with coronary heart disease are valuable,1 2 but there is little evidence on their lasting effect.3 A r and omised controlled trial in which patients who received personalised health promotion for two years showed significant benefits in lifestyle and quality of life.2 4 We investigated whether the differences in lifestyle , quality of life , and risk factors persisted between the two groups five years after enrolment . Patients aged under 75 who had had angina ( all grade s included ) for at least six months and no other concurrent serious illness were identified by 18 general practice s in Belfast . Their diagnosis was confirmed at interview , and they were r and omly allocated to receive either usual NHS care and personal health promotion from a trained nurse every four months for two years or usual NHS care alone . Sealed envelopes opened at interview showed group allocations . Both groups were review ed PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction , only 11 % to 38 % of eligible patients with cardiovascular disease ( CVD ) participate in cardiac rehabilitation programs .  Women and older adults are particularly less likely to participate in cardiac rehabilitation . In an effort to broaden access to cardiac rehabilitation , the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training , risk factor education , and monitoring services to patients with CVD . METHODS The evaluation consisted of a r and omized , clinical trial involving 104 patients with CVD , 53 of whom used the program as a special intervention ( SI ) for 6 months and 51 of whom received usual care ( UC ) .  RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects ( 15.7 % ) than among the UC subjects ( 4.1 % ) ( P = .053 ) , result ing in a gross cost savings of $ 1418 US dollars per patient . With a projected program cost of $ 453 USD per patient , the return on investment is estimated at 213 % . More weight loss occurred in the SI group ( -3.68 pounds ) than in the UC group ( + .47 pounds ) ( P = .003 ) . The differences between the two groups in terms of blood pressure , lipid levels , depression scores , minutes of exercise , and dietary habits were not statistically significant . CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD , either independently or in conjunction with traditional cardiac rehabilitation A r and omized controlled trial of two formats of a program ( Women Take PRIDE ) to enhance management of heart disease by patients was conducted . Older women ( N = 575 ) were r and omly assigned to a group or self-directed format or to a control group .  Data regarding symptoms , functional health status , and weight were collected at baseline and at 4 , 12 , and 18 months . The formats produced different outcomes . At 18 months , the self-directed format was better than the control in reducing the number ( p ≤ .02 ) , frequency ( p ≤ .03 ) , and bothersomeness ( p ≤ .02 ) of cardiac symptoms . The self-directed format was also better than the group format in reducing symptom frequency of all types ( p ≤ .04 ) . The group format improved ambulation at 12 months ( p ≤ .04 ) and weight loss at 18 months ( p ≤ .03 ) , and group participants were more likely to complete the program ( p ≤ .05 ) . The availability of different learning formats could enhance management of cardiovascular disease by patients STUDY OBJECTIVE : To investigate the cost effectiveness of personal health education for angina patients being treated in general practice . DESIGN : A r and omised controlled trial in which people were r and omised to intervention and control groups . All were assessed at the start and end of the study , with details recorded of disease status , coronary heart disease risk factors , and self assessed quality of life . A note was taken of their current use of drugs and over the course of the study their use of all health services . Those in the intervention group had three visits per year from a health visitor , whose brief was discuss ways of living more easily with their disease and in which risks of further events might be reduced . PATIENTS : Altogether 688 patents in the Greater Belfast area aged less than 75 years and known to have angina for at least six months . MAIN RESULTS : Significant improvements in survival and self assessed quality of life were found between the study and control groups . The intervention was associated with a reduction in drug usage and there was no significant difference between the intervention and control groups in terms of their use of other health services . CONCLUSION : Given the improvement in survival and self assessed quality of life and no significant differences in costs to the health service between the two groups , the intervention was deemed to be cost effective This paper presents findings from the evaluation of a self-management education program based on self-regulation principles . Older men and women ( N = 324 ) were r and omly assigned to program and control groups . Outcomes were measured using the Sickness Impact Profile . Twelve months following baseline data collection , psychosocial functioning of program participants was significantly better than that of controls . Different program effects were noted when results were analyzed by participant gender Aim of the study was to assess efficacy of educational technology -- School for patients with stable angina -- in conditions of practical health care . We r and omized 100 patients with ischemic heart disease ( IHD ) and stable FC I-III angina into 2 groups one of which went through learning in a School for patients with IHD  ( 6 90 min sessions 2 times a week ) . Patients of both main and control groups were followed up for 12 months . During the whole term of the investigation in both groups observation and treatment of patients was conducted by physicians of city polyclinic in accordance with generally accepted method of care of patients with diagnosis " IHD , stable angina pectoris " . Results of the investigation evidence that study ing in the School for patients with stable angina significantly elevates level of medical information adopted by patients , ensures positive dynamics of the whole row of clinical and psychological parameters as well as integral parameters of quality of life of patients with IHD CONTEXT Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care , patient adherence , and communication . OBJECTIVE To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries . DESIGN , SETTING , AND PATIENTS Eligible fee-for-service Medicare patients ( primarily with congestive heart failure , coronary artery disease , and diabetes ) who volunteered to participate between April 2002 and June 2005 in 15 care coordination programs ( each received a negotiated monthly fee per patient from Medicare ) were r and omly assigned to treatment or control ( usual care ) status . Hospitalizations , costs , and some quality -of-care outcomes were measured with cl aims data for 18 309 patients ( n = 178 to 2657 per program ) from patients ' enrollment through June 2006 . A patient survey 7 to 12 months after enrollment provided additional quality -of-care measures . INTERVENTIONS Nurses provided patient education and monitoring ( mostly via telephone ) to improve adherence and ability to communicate with physicians . Patients were contacted twice per month on average ; frequency varied widely . MAIN OUTCOME MEASURES Hospitalizations , monthly Medicare expenditures , patient-reported and care process indicators . RESULTS Thirteen of the 15 programs showed no significant ( P<.05 ) differences in hospitalizations ; however , Mercy had 0.168 fewer hospitalizations per person per year ( 90 % confidence interval [ CI ] , -0.283 to -0.054 ; 17 % less than the control group mean , P=.02 ) and Charlestown had 0.118 more hospitalizations per person per year ( 90 % CI , 0.025 - 0.210 ; 19 % more than the control group mean , P=.04 ) . None of the 15 programs generated net savings . Treatment group members in 3 programs ( Health Quality Partners [ HQP ] , Georgetown , Mercy ) had monthly Medicare expenditures less than the control group by 9 % to 14 % ( -$84 ; 90 % CI , -$171 to $ 4 ; P=.12 ; -$358 ; 90 % CI , -$934 to $ 218 ; P=.31 ; and -$112 ; 90 % CI , -$231 to $ 8 ; P=.12 ; respectively ) . Savings offset fees for HQP and Georgetown but not for Mercy ; Georgetown was too small to be sustainable . These programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined . CONCLUSIONS Viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings . Programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00627029
target: There was evidence to suggest that education can improve HRQoL and decrease healthcare costs by reductions in downstream healthcare utilization .
  Conclusions : Our review had insufficient power to exclude clinical ly important effects of education on mortality and morbidity .
background: Background : To assess the effects of patient education on mortality , morbidity , health-related quality of life ( HRQoL ) , and healthcare costs in people with coronary heart disease ( CHD ) .