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Technology-Based Disease ManagementA Low-Cost, High-Value Solution for the Management of Chronic Disease

 

作者: Wally H. Gomaa,   Thomas Morrow,   Pieter Muntendam,  

 

期刊: Disease Management & Health Outcomes  (ADIS Available online 2001)
卷期: Volume 9, issue 10  

页码: 577-588

 

ISSN:1173-8790

 

年代: 2001

 

出版商: ADIS

 

关键词: Asthma, treatment;Cardiovascular disorders, treatment;Diabetes mellitus, treatment;Disease management programmes;Pharmacoeconomics

 

数据来源: ADIS

 

摘要:

BackgroundAlthough information technology applications are part of all disease management programs, most programs involve extensive nurse interventions.ObjectiveTo present clinical and financial outcomes data from One Health Plan's technology-based program(s), which provide asthma, diabetes mellitus, and cardiovascular care to over 90 000 participants.MethodsThe programs are designed to support the health plan's patient population with asthma, diabetes, congestive heart failure, and coronary artery disease. Data from the health plan's medical and pharmaceutical claims were used to identify the total patient population. The program(s) use extensively mail, Internet, and Interactive Voice Response (IVR) services with only limited nurse interventions to engage the patients and intervene in their care.Patient engagement consisted of an introductory mailing supported by follow-up mailing. The objective was for the targeted patient to respond by completing a survey on paper, over the Internet, or via IVR. The CareResultsSMprogram, uses participant-reported information to risk stratify the population and to track patients progress as part of the measurements of the program's results. The risk stratification algorithm scores the participant's clinical status and ability to self-manage their care. Both dimensions impact the participant's risk score, which in turn determines the follow-up activities. CareResultsSMmails a personalized feedback booklet as part of a care kit to educate the participant on the current treatment protocols. The goal is to help the participant recognize good healthcare and teach them to work with their physicians to achieve this.ResultsThe programs demonstrate that improved outcomes can be rapidly achieved for a large number of participants without costly nurse interventions. One Health Plan offered the program to over 250 000 members in the year 2000 and had over 93 000 elect to participate. Improved clinical outcomes were demonstrated for asthma, diabetes, and the cardiovascular diseases. Highlights include a 55.2% increase in candidates with diabetes receiving glycosylated hemoglobin A1ctest, and a 27% self-reported increase in the use of low-dose aspirin for participants with a cardiovascular condition. Financially, current analysis comparing 1999 costs to 2000 costs indicates that the program's per member per year net savings ranged from $US300 to $US1000 depending on the specific disease state. In all cases, the programs demonstrated a significant positive gross saving.ConclusionOne Health Plan's experience demonstrates that the technology-based CareResultsSMprogram produces positive financial and clinical results without significant nurse interventions.

 

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