摘要:

Recent years have seen the beginning of an industrial revolution in healthcare delivery. Healthcare is being transformed from a cottage industry, in which each provider sets individual standards, to a quality-controlled enterprise with common, evidence-based standards of care. Disease management is fundamental to this transformation; it is based on the application of the industrial engineering principle of ‘total quality management’ to healthcare as ‘continuous quality improvement’.As little evidence has been published in the peer-reviewed literature regarding the cost effectiveness of disease management, specific disease management programmes should be judged by the extent to which its design adheres to the principles of continuous quality improvement. Disease management should, furthermore, be integrated into the overall activities of the healthcare system rather than being a carve-out offering.The true value of disease management is as a paradigm by which the healthcare system can re-engineer how it goes about its business − with clear goals, recognised standards and ongoing monitoring. The adoption of evidence-based best practice guidelines and the attendant reduction in practice variation will inevitably benefit millions of patients.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

A Community Health Information Network (CHIN) is a web-based net of computer systems which allows the electronic exchange of clinical, financial and administrative information among unaffiliated healthcare entities in order to improve the efficiency and delivery of healthcare in the community. It achieves this through a combination of services, products and technology.One field of application in which CHINs can be very effective is disease management; the aim of disease management is to align patient, provider and payer interests in order to enhance quality of care and cost savings. CHINs can be used to effectively and efficiently implement disease management programmes through linking disease management systems (i.e. computerised disease management programmes) with other information systems. The application of CHINs in the implementation of disease management programmes has many benefits including shared data, internal communication, external communication, value-added applications, bonding and marketing presence. However, there are also problems and pitfalls of an architectural and ‘emotional’ nature. Architectural problems relate to legacy system incompatibility, legacy functionality, external data representation, communications disparity, distributed governance, flexibility versus homogeneity, confidentiality, and size and scalability. Emotional problems include personal barriers, community and ethnic cultural issues, and suspicion between the various levels of care involved in an information exchange process.Many examples of operational CHINs can be found on the Internet. Although many challenges lie ahead for patients, healthcare providers and healthcare organisations in this field, these examples show that the use of CHINs will influence medical and healthcare practice in a positive way, especially in terms of disease management.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Breast cancer is the most frequently diagnosed cancer in women and the second leading cause of cancer mortality. It is estimated to account for approximately 20% of all cancer expenditures, making the burden of disease relatively high. One of the most important risk factors for developing breast cancer is age; with demographic trends towards an increasing elderly population in the US, this burden is likely to increase. Recent trends in healthcare delivery have increased the emphasis on evaluating costs of providing care as well as the outcomes of that care.This paper reviews breast cancer epidemiology, primary and secondary prevention and costs of breast cancer care by stage of disease at diagnosis and type of service, and discusses implications for the development of disease management programmes. Implementation of disease management programmes, through the creation of a data infrastructure system, establishment of measurable breast health and cancer care outcomes, and programme evaluation may be an important mechanism for managed-care organisations to provide quality and cost-effective breast cancer management.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Recent best practice guidelines recommend the provision of psychosocial family interventions for families of adults with schizophrenia. This article delineates the various family interventions and the empirical base of these interventions. These interventions include psychoeducation, family education, family consultation, and family support and advocacy groups. Although the provision of these interventions incur additional costs, they also have the potential for financial savings as a result of decreasing mental health service utilisation and improving outcomes for both the families and their ill relatives.The article concludes with recommendations for providers and organisations to improve effective relationships with families of adults with schizophrenia. Providers and organisations need to understand the needs of families, become knowledgeable about interventions for families and direct families to appropriate resources if they are unable to provide the family intervention themselves.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo examine the utility of a self-reported health perception assessment as a screening tool to predict high near-term utilisation of healthcare services.Design and settingProspective cohort study in a Midwest US commercial managed-care population. Participants completed a 70-question/126-response item paper-based health perception assessment (including demographic items) in late August 1997. Healthcare claims data were subsequently obtained from the health plan for the next 6 months and converted to total number of encounters and total dollars for each respondent. The dependent variable was the total number of encounters re-coded to a dichotomous variable with the cut-off set at 6 or more encounters as a subsequent high care user. All health perception assessment variables were dichotomised as well and then evaluated as independent variables for their ability to predict the probability that a member would become a high care user over the next 6 months.A split-half technique was used to identify the predictive model from the first half of the sample using logistic regression analysis. A formula was subsequently developed from that defined logistic model and then tested on the first split-half for levels of sensitivity and specificity. The chosen predictive formula was then tested using data from the other half of the sample.Study participantsA sample of 4210 non-institutionalised enrollees of the health plan, ranging in age from 18 to 65 years, who responded to an initial health perception assessment and were continuously enrolled in the health plan for the next 6 months.Main outcome measures and resultsUsing logistic regression for the first split-half of the sample, the resulting predictive model included 39 health perception assessment variables, correctly predicting 68.1% of the high care users and 61.9% of the low care users. The final logistic model was converted to a formula resulting in a probability score for each member, which indicates the likelihood the person will become a high utiliser in the near term. This formula was tested on both split-halves of the population yielding 66.7% sensitivity and 63.4% specificity on the first split-half and 59.4% sensitivity and 53.3% specificity on the second split-half. The predictive model permitted the number of health perception assessment survey questions to be lowered to 48 with 74 responses.ConclusionsEasily ascertained self-reported factors predict an adult's probability of becoming a near term high care user. Utilising a powerful self-report survey overcomes many of the limitations of using less predictive traditional health risk/status models or cumbersome claims stratification methods.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo assess the efficacy of a World Wide Web−enabled asthma self-management intervention on quality-of-life indicators among self-selected participants with asthma.DesignA quasi-experimental design was used in which quality-of-life outcome indicators were derived from the Mini Asthma Quality of Life Questionnaire (MiniAQLQ); this self-administered instrument includes a global score and 4 domain scores (emotional status, environmental triggers, symptoms and activity restrictions). Baseline and re-measure scores were statistically tested for change over a 6-month period of engaged participation.InterventionThe web-enabled interactive MyAsthma™ intervention which builds on patient-centred self-management skills based on education, appropriate medication usage and symptom control.ParticipantsA national sample of 437 patients with self-reported symptoms of mild intermittent to severe asthma who registered as participants in MyAsthma™. Engaged use of the Internet for building asthma self-management skills was examined as a construct of participation in the intervention.Main outcome measures and resultsBased on participants' self-reported responses, high volume users of the web-enabled intervention reported improved quality-of-life scores that were both statistically and clinically significant. Participants with a documented number of site visits greater than the group median (17 or more visits over the 6-month period of observation) were 1.6 times more likely to report an improvement in their global MiniAQLQ score compared with participants with less than the median number of visits [adjusted odds ratio (OR) = 1.60, 95% confidence interval (CI) 1.03, 2.48]. A similar effect associated with website visit frequency was observed with respect to participants' emotional subscales scores (adjusted OR = 1.76, 95% CI 1.09, 2.85) and activity subscale scores (adjusted OR = 1.64, 95% CI 1.06, 2.55).ConclusionsBased on pre-/post-test measures derived from a standardised and validated instrument, the web-enabled MyAsthma™ self-management programme was associated with a positive change in patient reported scores of quality of life. Although these results are preliminary and not derived from rigorously controlled clinical trials, the strength of this evidence is noteworthy nonetheless. We acknowledge that self-selection bias in observational studies is a threat to both internal and external validity. Research based on randomised clinical trials is needed to further document the effects of web-enabled disease management interventions targeting patients with asthma.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS