摘要:

Disease management relies on a team approach to chronic diseases for which good treatment regimens are known and national data are available. Limitations of and opportunities for disease management programs are explored and a case is presented that the inclusion of social work can enhance the performance, outcomes, and cost-benefits of disease management teams. Social workers can attend to depression, other mental health issues, resources, family support, and communication, when other team members may be less able to do so. Social workers are particularly well suited to help patients have voice in their treatment, and to participate actively as decision makers in their own care. Preliminary data show that inclusion of social workers in disease management programs enhances patient outcomes and cost benefits.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

An international literature search was conducted to identify studies published since 1995 examining the effects of diabetes self-management education (DSME) in community settings. Of the 24 publications identified, eight were examined to provide a discussion of intervention methods, the use by study authors of behavioral theories and models to explain cognitive and psychosocial processes, the employment of community partnerships and collaborations to enhance patient and community ownership of DSME, and the effects of DSME on intermediate- and short-term outcomes. Reported intermediate outcomes established that researchers are now beginning to recognize the complexity of diabetes.Interventions across publications included the use of lay health educators, family members in learning sessions, exercise classes in the community, support groups, and cooking demonstrations. Only two of eight studies identified a behavioral theory to explain cognitive and psychosocial processes. The lead agencies in all eight studies were medical universities or diabetes clinics that worked closely with community partners to deliver DSME in community settings. Community partners included diabetes centers, local churches, residential centers, and work sites. Studies in this review examined the effect of DSME on intermediate outcomes that included exercise, self-care behaviors, dietary habits, clinical service usage, self-esteem, social support, diabetes knowledge, and health beliefs, with one or more studies finding improvements in dietary habits, exercise, and diabetes knowledge. Short-term outcomes such as fasting glucose, glycosylated hemoglobin (HbA1c), body mass index, weight, blood pressure, total cholesterol, triglycerides, and impaired glucose tolerance were also examined.In at least one study, DSME favorably affected HbA1c, cholesterol, body mass index, blood pressure, and fasting glucose. Studies discussed in this review demonstrated the effectiveness of a single DMSE intervention delivered in community settings. DSME has proven effective in improving both intermediate- and short-term outcomes. This review also revealed opportunities to improve the effectiveness of DSME studies in community settings.Future DSME studies should give more attention to identifying appropriate behavioral theories or models that help explain the mediating effects of cognitive and psychological processes on diabetes self-management. DSME studies in the future should continue to improve study designs to strengthen the credibility of research findings, use both qualitative and quantitative methods to capture intervention effects; and engage community members and partners in developing, implementing, and evaluating DSME interventions.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Evidence-based medicine (EBM) is the conscientious application of scientific best practice by clinicians in concert with the patient’s understanding and values. Recent studies by the Institute of Medicine (Washington, DC, USA) and others have noted the gap that exists between scientifically supported approaches to care and day to day practice by clinicians. Compounding this problem of non-adherence by providers, researchers have noted that patient compliance also falls short. As a result, avoidable costs from inappropriate variability in practice patterns coupled with patient noncompliance are a significant focus of payor attention.Disease management programs, currently focused on chronic conditions, provide the most logical launch for these efforts. However, disease management programs must expand their focus to target non-adherence by providers in addition to noncompliance by patients. To this end, changes are necessary in the disease management model to enable physicians to be more actively engaged as coaches for acute and chronic patient populations and expand the use of information technology to increase participation in and the cost-effectiveness of these programs.Payors will migrate to this expanded model, thus providing expanded market opportunity for care management programs. Adherence to evidence-based guidelines by providers and patients will be the focus of these companies, with significant opportunity for reduced costs, reduced inappropriate variability and improved outcomes.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

In this article, we provide a practical and systematic framework to evaluate the cost effectiveness of health plans’ investments towards improvements in diabetes care. Through a literature search of PubMed and our own review, we identified research studies providing evidence on the cost effectiveness of diabetes management. Published and unpublished studies that address these issues are reviewed and synthesized in this paper, with the goal of assisting resource allocation decision makers in selecting the most appropriate and effective diabetes care improvement strategies available to meet the needs of specific care delivery systems and patient populations. We summarize this evidence as it relates to four areas:healthcare provider characteristics, the provider-patient relationship, and systems of care;clinical care decisions including the management of blood glucose, blood pressure, and cholesterol;models for improved delivery of care; andthe health plan perspective regarding returns on investment.Research data indicate that cost effectiveness varies by clinical domain. Blood pressure control, use of aspirin, and influenza and pneumococcal immunizations are cost saving in adults with diabetes across a wide range of ages and types of patients. Lipid control is most cost effective between the ages of 45–85 years, while the cost effectiveness of intensified glycemic control declines with age. Cost-effective diabetes management may be organized by primary care clinicians or by case managers working closely with either primary care or subspecialty physicians. Each delivery model has unique advantages and limitations, and there are insufficient data to compare the cost effectiveness of diabetes care across these organizational settings. Improving or enhancing a current model may require substantial investment. However, the resulting changes in the delivery of care may extend the benefits of improved management to other chronic diseases and to preventive care.There is evidence that patient activation, physician behavior change, and care system improvements may improve care, but the cost effectiveness of these strategies is incompletely understood at present. Selection of clinical goals for improvement is likely to have a major impact on cost effectiveness, with maximal return on investment for blood pressure control, aspirin use, immunizations, and smoking cessation. Effective diabetes care can be delivered across a wide range of care settings, including primary care clinics. The organizational characteristics of clinics and use of tools such as patient registries, guidelines, visit planning and active outreach to patients improve care, but returns on investment with regards to these specific strategies awaits further research.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

BackgroundAlthough various studies have reported the financial outcomes of disease management programs for commercial populations, few have addressed the outcomes for Medicaid recipients. McKesson Heath Solutions (MHS) disease management programs support clients whose members have serious chronic illnesses including asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, and mental health conditions. This study describes financial outcomes of the MHS asthma disease management program by evaluating changes in health services utilization measures for Medicaid members who participated in the asthma disease management program.The utilization rates for the three groups were compared in the pre- and post-program periods. The effect of group membership on inpatient admissions (IP), emergency department (ED) visits, and hospital outpatient department/physician office (MD) visits was analyzed using Poisson regressions. The regression analyses controlled for baseline levels of utilization, demographics, and relative risk scores generated by DxCG®software (manufactured by DxCG®in Boston, Massachusetts, USA).ObjectiveTo analyze and describe medical care utilization for asthma patients enrolled in a Medicaid managed care organization located in the eastern US.The utilization rates for the three groups were compared in the pre- and post-program periods. The effect of group membership on inpatient admissions (IP), emergency department (ED) visits, and hospital outpatient department/physician office (MD) visits was analyzed using Poisson regressions. The regression analyses controlled for baseline levels of utilization, demographics, and relative risk scores generated by DxCG®software (manufactured by DxCG®in Boston, Massachusetts, USA).MethodsMedicaid participants were identified and referred to the asthma program by the healthcare plan. Two comparison groups were used in the study to more reliably assess program impact. The first comparison group included members who were referred to the program, but who chose not to participate. The second group included members who were identified through medical claims data, but who were not contacted or referred to the program by the plan. All eligible participants with at least 30 days of program participation, and all non-participants with at least 30 days of effective plan enrollment in the pre- and post-program periods were included in the study.The utilization rates for the three groups were compared in the pre- and post-program periods. The effect of group membership on inpatient admissions (IP), emergency department (ED) visits, and hospital outpatient department/physician office (MD) visits was analyzed using Poisson regressions. The regression analyses controlled for baseline levels of utilization, demographics, and relative risk scores generated by DxCG®software (manufactured by DxCG®in Boston, Massachusetts, USA).ResultsWhile the MHS asthma disease management program has created positive financial outcomes for commercial populations, this study extends that scope to include a Medicaid population as well. 313 Medicaid participants experienced significant decreases in IP admissions and ED visits following program implementation. Participants also experienced decreased MD visits between the pre-program and program periods; however, their post-program MD visits were not reliably predicted by group membership after controlling for demographic differences and relative risk scores.ConclusionsThe experience of the MHS asthma disease management program demonstrates its efficacy and relevance to Medicaid populations. This study strongly suggests that a structured asthma program may create positive financial outcomes while promoting enhanced self-management through continued support, education, and patient involvement.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The rapid expansion of disease management continues. A multitude of stakeholders and marketplaces are now involved in providing cost-effective quality healthcare for individuals and populations. To help you keep up-to-date with the very latest developments in disease management, this section of the journal brings you information selected from the disease management and pharmacoeconomic reporting servicePharmacoEconomics & Outcomes News Weekly1. The following reports are selected from the very latest to be published across a broad range of literature sources.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS