ZuWallack - Figure 29
Fan: Disease Management
FIG. 29: This Figure shows the principal results of the Fan study; the results were also striking, but in a negative direction.[22] The graph (left) showing the probability of ED visit or hospitalization, i.e., the probability of failure, clearly reveals that the intervention did not work. The graph (right) showing the mortality difference unfortunately shows that the group with the higher mortality was the one that received self-management education. I was a member of Data Safety Monitoring Board (DSMB) for this study. We were blinded to the groups, and we were shocked when we unblinded the study and saw that the treatment group had the higher morality.
These discordant results generated a lot of discussion. The Rice study showed tremendous beneficial effects and no mortality signal at all, but the very similar study by Fan et al, with a more intense self-management intervention, showed no beneficial effect on hospitalizations or ED visits and even had a mortality signal. At this point we are still trying to discover what these discordant data represent.
References
Fan VS, Gaziano JM, Lew R, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations. A randomized, controlled trial. Ann Intern Med. 2012;156:673–683.
