AT HOME WITH HEART FAILURE & TRADE: EFFECT OF STANDARDIZED TELEPHONIC CASE MANAGEMENT FOR HEART FAILURE. B. Riegel 1 , B. Carlson 1 , Z. Kopp 2 , B. Lepetri 2 , A. Unger 3 ; 1 Sharp HealthCare, San Diego, CA; 2 Pfizer, Inc., New York, NY; 3 Science Applications International Corporation, Reston, VA PURPOSE: Case management that promotes heart failure (HF) self-care is thought to decrease the need for hospitalization but few randomized, controlled clinical trials have tested the approach. Since much of the effectiveness of case management depends on the unique abilities of the provider, decision-support software from Pfizer, Inc.,``At Home with Heart Failure TM '', was used to standardize care. METHODS: A prospective randomized controlled clinical trial was conducted to evaluate the effectiveness of software-supported telephonic case management in decreasing acute care resource use. 281 physicians from two hospitals in So. California were matched on specialty and practice size and randomized to intervention or usual care. Patients who were cognitively intact and spoke English or Spanish were identified during a HF hospital admission; 358 patients of the randomized physicians were included. Mean age was 72 years, 51% female, 56% unmarried, 72% class III or IV. The intervention group (n = 130) was telephoned within 5 days after hospital discharge and thereafter at a frequency guided by the software based on patient symptoms, knowledge, and needs. On average, patients received 17 calls (median = 14) from the case manager over the 6-month intervention period. Printed educational materials were mailed. Physicians were notified of patient progress in writing and telephoned as needed. Care for patients in the usual care group (n = 228) was not standardized. T-tests were used to test the hypothesis of equal mean acute care resource use in the two groups. RESULTS: Resource use was consistently lower in the intervention group: 6-month all-cause hospitalization rates were 27% lower (.62 vs. .86, p = 0.03), HF hospitalization rates were 48% lower (.22 vs. .41, p = 0.005), HF hospital days were 46%lower (1.1 vs. 2.1, p = 0.04). Multiple readmissions were 43% lower (.13 vs .23, p = .025). CONCLUSION: Standardized case management using telephonic decision-support software provided in the early months after a HF admission can augment care and significantly reduce acute care resource use. PURPOSE: In 1999, the Institute of Medicine reported that medical errors kill between 44,000 and 98,000 patients each year. There is little information on physician and public attitudes regarding disclosure of medical errors. METHODS: One thousand Colorado physicians were randomly selected to receive a mail survey describing three medical error scenarios (one minor, one moderate and one serious). The same three scenarios were presented to five hundred Colorado residents via telephone survey. For each scenario, the physicians and the public were asked if the error should be disclosed to the patient. The moderate error scenario was slightly modified from one previously tested and reported by M. Hingorani et al (BMJ 1999; 318:640 ± 1) . RESULTS: Response rates were 57%for physicians and 82%for the public. The public was less likely to desire disclosure of all three errors compared to physicians (p < 0.01) especially for the moderate error (p < 0.001) and the serious error(p < 0.045). Retired physicians (vs. active physicians, p < 0.05) and the over 65 public (vs. public under 65, p < 0.004) would not disclose the error for at least one of the scenarios. Primary care physicians (Internal Medicine, Family Medicine, Pediatrics, and General Practice) were more likely to disclose all three errors (p < 0.04) than non-primary care physicians. Physician response was not influenced by gender, years in practice, practice location or previous malpractice litigation. Desire for disclosure of the moderate error was roughly comparable for Colorado residents (88%) and United Kingdom respondents (92%). Gender, race, education, and income did not influence public response. CONCLUSION: Overall, 87% of Colorado physicians would disclose all medical errors to patients. The Colorado public was less inclined to disclose errors than physicians. Retired physicians and senior citizens were less likely to disclose one or more errors. Primary care physicians relative to all other physicians were most likely to disclose all three errors.