Effects of Hypertension Disease Management on Patient Outcomes in Taiwan

Objectives: The prevalence of hypertension in Taiwan is high and rises with age. Half of the top ten causes of death in Taiwan are hypertension-related chronic diseases. With the concept of disease management and the provision of appropriate treatment under clinical guidelines, patients can become more aware of their health status and keep their blood pressure under control to prevent the occurrence of possible complications. In this respect, on January 1, 2006, the Bureau of National Health Insurance implemented the policy of pay for performance, a concept in hypertension disease management. Since the practice of such a policy had not been evaluated as to whether it could help improve patient outcomes, this research aimed to explore the effects of hypertension disease management adopted in National Health Insurance, on patient outcomes.

Methods: The study design was retrospective secondary data analysis. The research used patient compliance and index of health care outcomes, such as medication days, clinic visits per individual patient and hospital admission rate due to hypertension complications, in order to evaluate the difference between the intervention group and control group before and after the enforcement of hypertension disease management. Logistic regression was used to analyze the odds ratios of both groups' after-intervention hospital admissions due to hypertension complications.

Results: On average, after the practice of hypertension disease management, patients in the intervention group were found to have significantly 27 more medication days, 1.18 more clinic visits, and 0.01 less admission than those in the control group. Secondly, in the logistic regression analysis on hospital admissions for hypertension complications, the control group was found to have a higher probability of hospital admissions due to cerebrovascular disease(Odds Ratio 1.78, p<0.0001)and cardiovascular disease(Odds Ratio 1.58, p<0.0001), than the intervention group after the implementation of hypertension disease management.

Conclusions: Compared to those who did not participate in the management program, patients who participated in the hypertension disease management were found to pay more periodical visits to clinics and to take more medications, with fewer hospital admissions for hypertension complications, such as cerebrovascular and cardiovascular disease, which means that this management program does help to improve the health care outcomes of hypertension patients. The research suggests continuance of the provision of disease management for hypertension patients and keeping track of the long-term effects of this program on the outcomes of hypertension patients.