Clinical InvestigationCoronary Artery DiseaseBenefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries
Section snippets
Demonstration design
Medicare's demonstration was designed to test the premise that aggressive cardiac risk factor reduction may slow, stop or even reverse the progression of CHD, improve health outcomes, and be a cost-effective or cost-saving use of Medicare funds. The participating lifestyle modification programs had multiple, geographically dispersed, clinical sites that were serving non-institutionalized individuals with CHD. Both fee-for-service and managed care Medicare beneficiaries were eligible to
Baseline characteristics
Of the 580 Medicare beneficiaries who participated in the demonstration, 461 (79%) were enrolled in fee-for-service Medicare and are the focus of this report. Sociodemographic and clinical characteristics of fee-for-service participants are summarized in Table II. Their mean age was 72 years, two thirds were men, more than 90% were white, 60% had received at least some college education, and 38% had completed a college degree or more.
More than one-third of participants (35.8%) had received
Discussion
Our study examined the clinical and economic benefits of two intensive, year-long, lifestyle modification programs in elderly Medicare beneficiaries who had had a cardiac event (AMI, CABG, or PCI) within the preceding 12 months or stable angina pectoris with documented myocardial ischemia. We assessed 3-year hospitalization rates, Medicare costs, and mortality. Comparisons are between MBMI and Ornish participants and matched controls who received either Medicare-supported CR or no CR. Both
Disclosures
No author had any relationship to industry or other conflict of interest that might have compromised the objectivity of the analysis or manuscript. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final content.
Acknowledgements
The authors thank Clare L. Hurley for assistance in preparing this manuscript. The principal funding organization (CMS) implemented the demonstration and approved the design of its evaluation by Brandeis University. Data collection and adherence to lifestyle modification protocols were monitored by the Delmarva Foundation for Medical Care, Inc. a CMS-contracted Quality Improvement Organization in Easton, MD. We are particularly grateful to Roxanne Rodgers, PMP, RN and William J. Oetgen, MD, MBA
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