AHRQ Focus on Research
Chronic Disease in Adults
Discusses major diseases affecting the U.S. population and the impact of AHRQ research in reducing cost and improving quality of care.
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Scope of the Problem / Background / Impact of AHRQ Research / Current AHRQ Chronic Disease
Research Priorities / For More Information
Scope of the Problem
About 108 million people in the United States have at least one
chronic disease such as heart disease, diabetes, asthma, hypertension,
or osteoarthritis. These conditions have severe impact upon the
quality of peoples' lives and health care costs. For example:
- Approximately 1.7 million hospitalizations occur annually for a
heart attack or congestive heart failure, and over 600,000 people
die each year of heart disease.
- Nearly 50,000 people die each year as a result of diabetes, making
it the sixth leading cause of death.
- Health care costs for asthma patients rose dramatically from $4.5
billion in the 1980's to $10.7 billion in the 1990's.
- Over 50 million people suffer from high blood pressure
(hypertension), which contributes to the incidence of stroke and
heart disease.
- More than half of people age 65 and over have evidence of
osteoarthritis; it is the major cause of disability in this age group.
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Background
As our population ages, more and more
people will develop chronic disease, placing an
unprecedented burden on families, purchasers
of care, and health care providers. For over 30
years, the Agency for Healthcare Research and
Quality (AHRQ) and its predecessors have
sponsored and supported research on improving
quality of care and health outcomes for chronic
disease.
AHRQ research has helped develop
and evaluate interventions and tools to improve
management of chronic disease in clinical
practice. AHRQ research has helped identify
areas where management of chronic disease can
be improved.
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Impact of AHRQ Research
Heart Disease
- Reduced costs. Patients with heart failure
who were enrolled in a home-based
monitoring program had fewer medical
claims and lower health care costs than
patients not involved in the monitoring
program. Medical claims decreased for
patients enrolled in the monitoring program
from $8,500 to $7,500 but claims for patients
not participating in the program increased
from $9,200 to $18,800. The cost of the
monitoring program was less than $200 a
month for each patient.
- Improved quality of life. When patients
with heart failure engaged in a home-based
walking and resistance training program,
their quality of life improved, according to
AHRQ researchers. These patients had less
fatigue, better emotional function, and more
control over their symptoms with no reports
of injuries or cardiac problems related to the
exercise program.
Diabetes
- Better blood sugar control. AHRQ
researchers found that by using a
combination of two medications or an oral
medication plus insulin, 87 percent of diabetics
achieved good control of their blood sugar.
A second study found that patients who
participated in an automated telephone
disease management (ATDM) program to report their blood sugar readings as measured
by hemoglobin A1c test had better blood
sugar control, resulting in a 0.3 percent lower level.
Asthma
- Improved outcomes and lower costs.
Treating patients with asthma in an
emergency diagnostic and treatment unit
(EDTUs) rather than admitting them to the
hospital resulted in an average reduction of
$1,000 in costs per patient, according to
AHRQ researchers. EDTU patients averaged
approximately $1,200 per visit while patients
admitted to the hospital averaged $2,200 per
visit. There were no differences in relapse
rates between the two groups and patients
treated in the EDTU expressed more
satisfaction with service.
High Blood Pressure
- Improved quality of life. Men and women
with mild diastolic hypertension benefited
more from treatment with the anti-hypertensive
drug propranolol than from diet
modifications, increased exercise, and
relaxation techniques. An AHRQ study
found that patients who received propranolol
had significantly better control of their
diastolic blood pressure than those who did
not receive propranolol regardless of their
lifestyle changes. In addition, propranolol
had very few reported adverse effects on
mental functioning or quality of life.
Osteoarthritis
- Improved quality of life through
occupational therapy. Preventive
occupational therapy may lessen health risks
in older adults with osteoarthritis.
Participants in the AHRQ-funded Well
Elderly study group reported better
interaction with other people, self-perceived
health status, satisfaction with life, mental
health, and improvements in pain, physical
and social functioning, vitality, and fewer
emotional problems when they underwent
preventive occupational therapy to avoid
functional disability.
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Current AHRQ Chronic Disease
Research Priorities
AHRQ is continuing to fund numerous
studies and sponsor projects that will help
prevent and manage chronic disease. Examples
of these studies include:
- Cardiovascular disease. At Duke
University, a Center for Education and
Research on Therapeutics (CERT) is
collecting data on improved use of new drugs
and working with the Food and Drug Administration on surveillance
programs for cardiovascular devices.
- Diabetes care. Researchers at the University
of Illinois at Chicago are developing a new
computer program to provide diabetes
education to improve knowledge, attitudes,
and increase compliance with self-care.
- High blood pressure. Researchers at the
Mount Sinai School of Medicine in New
York are assessing the underlying causes of
the underuse of effective health care services
among blacks and Hispanics and will
develop, implement, and evaluate
interventions to eliminate underuse.
- Arthritis. The CERT at the University of
Alabama at Birmingham is focused on
musculoskeletal disorders including an
arthritis center to disseminate new
knowledge about therapeutics.
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For More Information
For more information on AHRQ's research
on chronic disease, contact:
Heddy Hubbard, R.N., M.P.H.
Center for Outcomes and Effectiveness
Research
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 6000
Rockville, MD 20850
Phone: (301) 427-1494
E-mail address: HHubbard@ahrq.gov
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AHRQ Publication No. 02-M026
Current as of March 2002
Internet Citation:
Chronic Disease in Adults. AHRQ Focus on Research. AHRQ Publication No. 02-M026, March 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/focus/chadult.htm
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