To the Editor: In their meta-analysis of management of discharge planning for older patients with congestive heart failure, Drs Phillips and colleagues1 concluded that these programs were associated with an approximately 25% relative reduction in the risk of readmission. We are concerned about the way that the authors categorize the interventions. As primary investigators of 8 of the 18 trials the authors included in their meta-analysis, we believe that these categories obscure true differences among programs.
We also believe that categorization of programs according to the predominant method of intervention is flawed because it incorrectly presumes that every program applies a core set of components with similar intensity. Furthermore, targeted programs that focus on only 1 or 2 management issues (eg, patient education) are different from those that take a more comprehensive approach.
For instance, the study by Jaarsma et al2 used a targeted intervention focused on increasing self-care behaviors, while Stewart et al3 applied a multifactorial intervention with a home visit, telephone follow-up, and reorganization of community-based services. We are puzzled why the study by Jaarsma et al2 was not included in the same category as that of Krumholz et al.4 We have similar concerns about similarities between home-based programs adapted to local health care environments conducted by Stewart et al,3 Naylor et al,5 and Blue et al.6
We recommend that disease management programs be categorized on the basis of mode of intervention (eg, telephone), complexity, and intensity. We also suggest that rather than relying on limited descriptions from published reports, each investigator should nominate his/her program category according to universally agreed-upon criteria.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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