The Stanford Chronic Care Management System

Government

Information for Government Agencies

Government agencies such as the Centers for Medicare and Medicaid Services (CMMS) are actively seeking out innovative programs that reduce the costs of care while maintaining the quality of care. Indeed, during the past 5 years, CMMS has sponsored clinical trials of innovations such as care management that were designed to achieve this goal. However, the results of these trials were decidedly mixed and there is no consensus on how to proceed in the future.

The Stanford Chronic Care Management System is one of the most highly leveraged initiatives yet proposed to address the costs of managing chronic medical conditions. SCCMS provides the considerable advantage of first contact with patients, even before 911 and other treatment alternatives are considered. SCCMS enables tailoring of the medical response to the needs of individual patients who initiate telephone contact with the program.

Pilot studies demonstrate that prompt telephone triage substantially reduces the frequency of ER visits and hospitalizations in patients with known coronary artery disease, substantially reducing overall system costs.

It is commonly perceived that major changes in healthcare delivery require many years of study, including randomized clinical trials involving many thousands of patients and costing many millions of dollars. Even when the efficacy of innovations is established, many additional years are often required for the innovation to take hold in treatment practice.

SCCMS is different for the following reasons:

  1. The scientific basis of SCCMS, including methods for evaluating prognosis, is already well established.
  2. The elements of the telephone triage system linking patients with SCCMS staff and the database used as the repository of clinical data in SCCMS, are already established.
  3. The facilities that SCCMS relies on for the delivery of clinical care, including the outpatient clinic, the Urgent Care clinic and the ER, already exist.
  4. The only remaining objective required to foster nationwide implementation of SCCMS is the demonstration of the safety of SCCMS and the satisfaction of patients and physicians with SCCMS.

Achieving these benchmarks is now the focus at Stanford. We are conducting clinical research with a variety of collaborators in the healthcare field.

How many patients monitored with SCCMS would be required to assure nationwide dissemination of this system? Between several hundred and several thousand.

Depending on the number of collaborators involved, this level of experience could be obtained within 12 months. It would not be necessary to randomize patients, since the elements of the present system of healthcare delivery have been unchanged for many years. It would be necessary only to match patients receiving SCCMS with those treated under the present system in previous years.

Nearly 15 million Americans have coronary artery disease, and nearly two-thirds of them are 65 or older. All are potential users of SCCMS.

This system could dramatically restructure the care of these patients by shifting the emphasis of care from the ER and hospital to the Urgent Care clinic and the outpatient clinic, resulting in huge savings.

In addition, SCCMS will help to coordinate the follow up care of patients initiating contact with SCCMS, assuring that patients receive optimal doses of recommended pharmacotherapy, and undergo needed tests to direct their future use of revascularization procedures. For example, the “open artery” hypothesis, which held that patients with established coronary artery disease would benefit from opening up previously occluded coronary arteries, even in asymptomatic individuals, was disproven by a major randomized clinical trial. This expands the potential of systematic and meticulous pharmacotherapy to favorably alter the prognosis and functional status of patients with coronary artery disease.