摘要:

There is a range of interesting approaches to integrate patients' views into disease management systems in order to implement evidence-based practice, and improve patient adherence to treatment and patient satisfaction with care. Information can be provided to stimulate appropriate use of healthcare and to choose a care provider. Patients can provide data on their health status and other relevant issues to the care provider prior to an appointment, and the patient can be prepared for active participation. In the contact between a clinician and patient, tailored patient information, shared decision-making and methods to stimulate patient adherence can be used. After the contact, patients can give feedback on the care provided in terms of evaluations, complaints and comments. Research evidence suggests that all available methods can have positive effects, but that this evidence is fragmentary and incomplete. Small scale experiences and well-designed studies are needed to develop feasible, valid and effective methods in this area.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

This paper examines the form of performance-based contract which is relatively new to healthcare systems. Economic theories on contracting are reviewed to provide theoretical support for potential impacts of performance-based contracting (PBC) on improving efficiency of the healthcare system. Implementation issues of PBC in healthcare practice are briefly discussed with examples in the literature reviewed. In addition, various economic incentives of PBC on provider behaviour are discussed, including its primary intended incentive on improving system efficiency, as well as incentives of risk selection on patients, improved matching between providers and patients, and gaming on reporting.In summary,with a simple and economically valid idea of ‘rewarding good performance’ behind it, PBC is a potentially powerful contracting tool that could improve accountability, introduce competition, and improve the efficiency of healthcare resource allocation. In practice, PBC has been implemented and tested in various settings. Some preliminary evidence suggests that the implementation of incentive regulation such as PBC could increase healthcare outputs including access, quantity and effectiveness as well as reduce costs of care. However, it also introduces complicated incentives on providers which makes the evaluation of the effect of PBC on healthcare systems a challenging task, both theoretically and empirically. Furthermore, there are various practical issues, such as measurement of performance, which remain unsolved and make the implementation of PBC controversial. In the meantime, development of PBC in healthcare systems should remain cautious. More research on outcome evaluation and treatment effectiveness is needed to establish the link between financial incentives and healthcare outcomes.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

The effectiveness of disease management programmes hinges on a combination of factors, all of which are important to consider when selecting a programme for implementation. This article provides a brief overview of disease management programmes commonly found in healthcare organisations, highlighting the issue of programme effectiveness.Seven factors critical to the design and development of an effective disease management programme are outlined to guide practitioners and healthcare managers who are responsible for making decisions about such programmes. These decision factors are:defining and establishing programme goals;defining a target population;selecting measures of programme success;determining data availability and information systems capability;deciding to build or buy all or parts of a programme;determining and enhancing the level of physician involvement; andselecting strategies to enhance organisational support.Careful consideration of these factors in the decision stage for a disease management programme will help ensure effective and appropriate programme development and implementation. Healthcare managers applying these considerations will be better able to develop disease management programmes that achieve their objectives and provide a foundation for organisational success.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

This article describes recent developments in remote patient self-management programmes for care management. An overview of current practices in disease management, care management and quality improvement is provided along with descriptions of enabling technologies including interactive voice response (IVR) and new patient communication and data capture systems. A new technology platform for disease management, case management and performance measurement − the Health Hero®online service − is presented and described. The Health Hero®platform features a patient information appliance (the Health Hero®Health Buddy®appliance), a central data centre, and an Internet-based service facilitating the daily activities of patient- and population-based care management, disease management and performance measurement.Results from preliminary field testing of the Health Hero®online service are presented. These result indicate that compliance (usage) with the Health Hero®online service is consistently above 80% and that patient satisfaction is high. Surveys conducted on the Health Hero®online service indicate the device is easy to set-up and use, and that the likelihood of patients' continuing to use the Health Hero®online service is high and increases with time (from 80 to 93% over 3 months). Remote patient care management systems, such as the Health Hero®Internet-based communications platform and some IVR systems, facilitate efficient monitoring of patients. They consequently provide a foundation for better outcomes and quality of life for patients and reductions in the cost of healthcare delivery.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Background and ObjectiveA growing body of literature on the economics of depression concludes that this illness has an enormous impact on workplace performance. In addition to work cutback and sporadic absenteeism, the symptoms of depression also result in elevated rates of chronic absenteeism that manifest in the form of workplace disability.Design and SettingUsing a unique data source that contains the medical, pharmaceutical and disability claims of a national US manufacturer, we measured the extent of disability before and after initial treatment for major depression.Participants1260 employees with at least one medical or disability claim for major depression based on International Classification of Diseases, 9th edition (ICD-9) codes in 1996 or 1997.ResultsWe estimate that the decreased disability payments in the first 30 days following initial treatment for major depression results in employer savings totalling $US93 per patient, which can exceed the cost of treatment for a similar period of time. These disability savings do not incorporate several additional sources of likely cost savings to the employer, and thereby underestimate the workplace offsets associated with depression treatment. Additional benefits to the employer from the treatment of depression include reduced work cutback and decreased sporadic absenteeism of treated employees, reductions in some types of medical and prescription drug expenditures following appropriate depression treatment, and productivity improvements by employees serving as caregivers for treated spouses and children. Furthermore, to the extent that new pharmaceutical products offer advantages in the workplace over existing treatments for depression, the first month of such treatment will be associated with workplace savings that exceed per-patient estimates reported here for current treatment modalities.ConclusionsThe findings from this analysis imply that the workplace benefits from improved functioning are substantial and may in fact exceed the usual costs of depression treatment. Thus, purely on economic rather than clinical or quality-of-life grounds, this argues in favour of more aggressive outreach to employees with symptomatic disease that results in initiation of treatment before their symptoms are allowed to persist and result in a disability claim. In this light, detection and treatment of depression in the workplace can be seen as important components of community-based disease management programmes.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS