摘要:

Disease management has become an increasingly popular tool used to manage people with chronic diseases in managed care organizations. The implementation of these programs, coupled with pressures to document quality and control costs, has increased the need for information regarding the health services provided to patients. This paper gives an overview of selected topics involved in data collection, including medical record review, databases, automated systems, and disease management software. The preliminary uses of the Internet and wireless technology are also discussed.Efficient data collection requires the identification of pertinent information from clinical, patient-reported, and economic data. Several sources provide this. The medical record is considered the gold standard for providing clinical information. However, collecting this data can be time consuming and expensive. Claims that databases have gained popularity for their comprehensiveness and accessibility are eroded by the lack of detailed clinical information. Direct communication with patients via telephone is commonly used in disease management programs, but its effectiveness as a data collection tool is not well documented. The use of the Internet and wireless technology in data collection is an exciting opportunity, since it provides interactive access between providers, patients, and the managed care organization.In most cases, a combination of data sources will be required to collect all the necessary information. However, claims databases, medical chart review, and telephone interviews are the backbone of data collection in disease management. The computerization of medical information systems, and use of the Internet and wireless technologies, should facilitate future data collection.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

The evaluation of outcome of management of patients with angina pectoris is now inextricably linked with an assessment of quality of life. Angina pectoris, as a manifestation of coronary heart disease, is a major cause of morbidity and mortality in many countries. Optimal management of patients with angina pectoris is of undeniable national and global significance.This paper indicates the importance of a team approach and the implications for patients' quality of life of involving professionals with a variety of different skills. Current guidelines for the management of patients with angina pectoris include aspects of diagnosis, treatment and rehabilitation which involve multi-professional input. A wide variety of factors have relevance to the management of patients as individuals. A coordinated team approach should lead to improved quality of life and reduced severity of symptoms for these patients and benefit for both the individual and society.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Health outcomes measurement has become increasingly important in the care of patients with end-stage renal disease (ESRD). Interest has been stimulated by the relatively poor outcomes of patients with ESRD, variations in the process of care, the high costs of ESRD care, and the development of practice guidelines.There are a number of key outcome measures that can contribute to improving the care of patients with ESRD. Mortality, measured as the standardized mortality rate, remains a commonly used outcome measure. The standardized hospitalization rate is one measure of morbidity. Other important measures include:transplantation rates;the proportion of patients with an appropriate hematocrit;the proportion of patients with usable vascular access at the initiation of hemodialysis;rates of vascular access failure; and (v) the mean urea reduction ratio.Quality-of-life measurement is becoming increasingly useful to providers of ESRD care. More experience is being gained with disease-specific quality-of-life instruments.Providers must be aware of the challenges that remain in health outcomes measurement and disease management. Resolving problems with case mix adjustment, managing the costs of measurement, extending outcomes measurement to pre-ESRD care, and developing strategies to couple outcomes measurement with efforts to improve patient care are important goals.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveThe objective of the study was to develop a procedure to distribute health resources among treatments for the primary prevention of coronary heart disease based on efficiency and equity.Design and SettingTwo procedures to manage pharmaceutical resources for the primary prevention of coronary heart disease in Catalonia, Spain, were developed in this study. The following treatments were considered in these procedures: medical advice and nicotine substitution therapies for smoking cessation; hydrochlorothiazide (diuretic) and propranolol (β-adrenergic antagonist) for moderate/severe hypertension; hydrochlorothiazide and nifedipine (calcium antagonist) for mild hypertension; and lovastatin (HMG-CoA reductase inhibitor) for hypercholesterolemia higher than 7.23 mmol/L or 2.7 g/L.ResultsThe first procedure was developed based on decision rules of cost-effectiveness analysis, giving a higher priority to treatments with a higher cost effectiveness. The second procedure was developed based on efficiency and equity, deciding allocation of resources based on cost-effectiveness and social preferences. Annual cost of treatments ranged from $US147.30 per individual for smoking cessation to $US2555.20 per individual for treatment with lovastatin 80 mg/day (1998 values). Resources should be allocated in the following order, according to the procedure based on decision rules of cost-effectiveness analysis, to smoking cessation therapies, hypertension treatments and hypercholesterolemia treatments. This is in contrast to the procedure based on efficiency and equity, where a higher priority should be given to the most cost-effective treatment for hypertension, hypercholesterolemia and smoking. The efficiency and equity strategy could reduce the amount of resources necessary to treat all individuals at risk by 26 to 47%, according to age and gender.ConclusionsThe procedure based on efficiency alone should be used when the objective is to maximize health gains from available resources. The procedure based on both efficiency and equity should be used when society has an aversion to inequality in the distribution of health gains, treating all individuals with coronary heart disease risk factors at the lowest cost.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

BackgroundThe use of utility values in cost-effectiveness analysis is an accepted method for defining outcomes. Increasingly, cost-effectiveness analyses examine outcomes that involve two or more health states. There is no accepted method of mathematically combining single health state utility values into a surrogate value that represents the combined health state.ObjectiveTo test the effect of different mathematical approaches to combining single health state utility values into a surrogate value on the cost-effectiveness ratio, in a sample model.MethodsWe employed a realistic decision analysis model to test the cost-effectiveness of screening for postpartum thyroiditis. Utility values for type 1 diabetes mellitus and thyroiditis were taken from the literature and combined using different methods.ResultsThe surrogate utility values obtained using the multiplicative method were higher than those obtained with the additive method (for example, the state of both type 1 diabetes mellitus and treated thyroiditis had a value of 0.75 for the multiplicative method versus 0.73 for the additive method). The resulting cost-effectiveness ratios for the screening strategy were slightly higher, $US16 000 (1998 values) per quality-adjusted life-year (QALY), for the multiplicative method when compared to the additive method ($US14 000 per QALY). This small difference was consistently maintained during sensitivity analyses.ConclusionAll methods of combining utilities resulted in similar values. Until a consensus is reached on the method of choice, researchers should consider using both methods in sensitivity analyses and reporting both sets of results.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS