摘要:

Disease management programs in the US were originally developed for the small minority of patients who consumed a large portion of healthcare resources, were complex cases to manage, or had specific chronic conditions. Although they vary in structure and are hard to describe with a single definition they usually contain one or more core components which may include the use of evidence-based practice guidelines, integrated information systems, and continuous quality improvement activities and processes. The literature describing disease management program outcomes and cost savings has been lacking, and published results tend to lack rigorous scientific discipline.The future and success of disease management will be measured by the efficacy of programs that impact the needs of individuals who have multiple chronic conditions. New second-generation programs will be designed around population-based methods to identify individuals with chronic illnesses, a primary care team that provides individualized medical management, documentation of outcomes beyond traditional utilization and cost measures, and quality improvement processes that identify areas for improvement through integrated information technology systems. In 2002, the Center for Medicare and Medicaid Services will begin operation of the Medicare Coordinated Care Demonstration project, a 4-year study to test whether combined disease and case management programs can improve clinical outcomes, satisfaction, quality of life, and cost outcomes for beneficiaries with multiple chronic conditions. If the demonstration is successful it has the possibility of placing second-generation disease management programs at the forefront of chronic illness management.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

In this article, the issue of who benefits from managed drug use in assisted living and home care settings is addressed from a clinical perspective. Benefit in clinical terms is always focused on the patient as an individual and not on the system or process of providing managed drug use. Indeed, the traditional definition of managed drug use is abandoned in this article. Rather, managed drug use is defined as ‘the appropriate and rational use of drugs based on the patient's individual and unique medical history and current diagnoses and encompasses the use of prescribed, purchased and consumed drugs.’ Because the majority of patients receiving healthcare in the assisted living or home care setting are elderly, the question ‘how can drugs be managed more appropriately?’ in the older population in the assisted living and home care setting is posed. While the answers to this question are not complex nor original, the authors of this article believe they serve as the foundation for achieving optimal ‘managed drug use’ in assisted living facilities and in the home.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

The traditional formulary review process possesses limitations that impair a Pharmacy and Therapeutics committee's ability to thoroughly evaluate products, including the lack of emphasis on a product's impact on humanistic outcomes and the use of cost comparisons which fail to evaluate the budgetary impact on all aspects of medical expenses. Emerging formulary submission guidelines offer some improvements to these traditional reviews, but fail to address several key issues; most notably these guidelines do not impart provisions for the completion of needed outcomes research.Designed to facilitate the collaboration of the manufacturer, health plan, and outcomes research organization in the design, conduct, and completion of outcomes research, WellPoint Pharmacy Management's Outcomes-Based Formulary helps to limit or eliminate gaps of information in the product portfolio while ensuring that the patient population studied matches that of the health plan. The Outcomes-Based Formulary will provide a participating health plan's Pharmacy and Therapeutics committee with a wealth of information, including effectiveness and humanistic data, with which the most informed formulary decisions can be made.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Healthcare institutions, such as hospitals, are made up of highly distributed and complex organizational structures and processes. As such there is an increasingly large number of information interfaces between various involved healthcare professionals, making efficient organization of patient care and disease management difficult. Innovative information technology, such as electronic patient record systems, may have the potential to support patient care by improving information logistics and information management.In this paper, we present a case study dealing with the use of information technology in clinical psychiatry. We first present the results of a detailed systems analysis which showed large deficiencies within multi-professional patient care in the psychiatry department, such as missing central representation of the course of patient care, and an enormous amount of oral communication. These deficiencies can be overcome by a central patient record, supporting all phases of care and all professional groups. We present an electronic record system, implementing these recommendations, as an example to support the nursing part of the process of care. Such a system was introduced and evaluated on two psychiatric wards of the University Medical Center Heidelberg. The evaluation results show improved quality of documentation and a better support of the care process.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Migraine is a highly prevalent, chronic, episodic condition. The direct and indirect costs of migraine have a large economic impact. Research has shown that migraine abortive medications reduce healthcare costs, improve health-related quality of life, decrease migraine disability and keep patients effective in the workplace. This class of medications, therefore, has a clearly defined role within a disease management program. However, the role of prophylactic medications in terms of costs and patient-focused outcomes within a disease management program has not been clearly defined.Based on a review of the US Headache Consortium Evidence-Based Treatment Guidelines and an examination of issues surrounding prophylactic medications, we conclude that the role of preventive therapy in terms of costs and patient-focused outcomes is not clearly defined. Currently, there are insufficient data available to assess the impact of migraine prophylactic therapy on costs and patient-focused outcomes. Hence, it is premature to state the precise role of preventive therapy in a migraine disease management program. Additional research is needed to better delineate the criteria for migraine prophylaxis, to validate clinical efficacy studies of preventive therapy, to determine the cost-effectiveness of prophylactic therapy, and to determine the effect of preventive therapy on patients' health resource use, health-related quality of life, and lost productivity.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectivesTo compare the experience of one managed care organization (MCO) [Anthem Blue Cross and Blue Shield Midwest Region] to the experience of a reference group of 15 other MCOs participating in a study designed to test the usefulness of outcomes management information in developing and implementing interventions to improve the quality of care in asthma.Study designProspective study.Patients and methodsAdult patients with moderate or severe asthma enrolled in sixteen participating MCOs who completed an initial baseline survey in 1993 and follow-up surveys in 1994 and 1995. Data analyses focused on differences between Anthem and the reference group at each round of data collection as well as longitudinal analyses of changes over time.ResultsBaseline data suggested some deficiencies in care at all MCO sites. Cross-sectional comparisons between Anthem and the reference group revealed statistically significant differences in outcomes measures (hospitalization and emergency room visits, canceled activities per month because of asthma, asthma attacks per month, and work days lost in the past month). Improvements in these outcomes were reported over the subsequent two years. Patients at Anthem reported a significantly greater increase in peak flow meter (PFM) possession than did those in the reference group (p = 0.01) which may have resulted from an administrative change that made PFMs a funded item. However, other interventions (e.g. educational programs) may have also contributed to the improvements.ConclusionsThis study illustrates the ability of MCOs to collect and use patient-reported outcomes data to monitor and improve patient care. Such information allowed this national group of participating MCOs to identify deficiencies in quality of care provided, design tailored interventions and measure the potential impact of these interventions on patient care.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

BackgroundAnemia often develops among patients with chronic kidney disease (CKD) and is an important cause of cardiovascular disease among patients with end-stage renal disease (ESRD).ObjectiveTo evaluate the epidemiology and treatment of anemia among patients with CKD by undertaking an analysis of data from one Health Maintenance Organization.MethodsThe CKD cohort was comprised of 1658 patients followed between 1 January 1994 and 1 December 1997 who had serum creatinine (SCr) levels above gender-specific norms. The prevalence of anemia and epoetin-α (recombinant human erythropoietin) use was determined, and the association with anemia and kidney function was assessed with multinomial logistic regression analysis.Results36% of patients with CKD had anemia, with at least two hematocrit (HCT) values (separated by ≥30 days) lower than the gender-specific norm (<42% for males, <36% for females). Eleven per cent of patients had a lowest HCT value less than the gender-specific norm but ≥33%, 6% had a lowest HCT value 30 to 32.9%, and 19% had a lowest HCT value <30%. The prevalence of anemia was positively correlated with the severity of kidney dysfunction.In the multivariate analysis, the independent relative risk of an HCT value <30% versus no anemia was 84.5, 9.8 and 2.0 for patients with SCr level ≥4.0, 3.0 to 3.9 and 2.0 to 2.9 mg/dl, respectively, compared with patients with SCr level <2.0 mg/dl. Epoetin-α was prescribed for only 7.4% of patients and, more significantly, for only 23% of patients with an HCT value <30%. Even among patients with an HCT value <30% who had received care from a nephrologist, only 66% received epoetin-α.ConclusionsThis study demonstrates that the prevalence of anemia among patients with CKD is high and the management of anemia is suboptimal. Suboptimal treatment of anemia during CKD may lead to increased cardiovascular morbidity and cost of care among patients with CKD and ESRD.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS