Predictors of disease management program enrollment among U.S. older adults with chronic conditions

Recent studies have shown that disease management programs (DMPs) are associated with improved patient health and costs outcomes. However, the current understanding of the impact of individual and physician practice characteristics on DMP enrollment is limited. The objective of this study was to examine the impact of these characteristics on DMP enrollment among a nationally representative sample of older adults with chronic conditions. We used data from the National Ambulatory Medical Care Survey (NAMCS). We identified patients with at least one of thirteen chronic conditions (depression, diabetes, hypertension, heart disease, CHF, COPD, obesity, and etc.). We used multivariate regression model to estimate the probability of DMP enrollment while controlling for individual, physician practice, and other characteristics. The sample consisted of 6961 office visits made by patients, representing 20% of the 994 million total visits to physician offices in 2007. The mean age of the sample was 75.6 years and 56.1% were female. The average patient had 2.5 chronic conditions. Twenty-two percent visits were made to general or family practices. Results indicated that patients from rural areas were 40% less likely to be enrolled in a DMP program (OR=0.60, p<0.01). Other significant predictors for DMP enrollment included younger age, insured patients, visiting a specialist, having more chronic conditions, corporate ownership of the practice, and residing in the Northeast. These findings suggest that enrollment in DMPs for older adults with chronic conditions should be promoted, especially among those who live in rural areas, so that better outcomes can be achieved.