摘要:

The burden of chronic diseases is tremendous, and traditional methods of healthcare delivery are unsuitable for addressing these needs. Chronic disease management has emerged as a new strategy for chronic disease care, but a consistent definition has not been utilized. Our objective is to present an operational definition of chronic disease management. Based on prior systematic reviews of chronic disease management programs, we propose a definition encompassing the main constructs noted in our reviews.We define chronic disease management in the clinical setting as an organized, proactive, multi-component, patient-centered approach to healthcare delivery that involves all members of a defined population who have a specific disease entity (or a subpopulation with specific risk factors). Care is focused on, and integrated across the entire spectrum of the disease and its complications, the prevention of comorbid conditions, and relevant aspects of the delivery system. Essential components include identification of the population, implementation of clinical practice guidelines or other decision-making tools, implementation of additional patient-, provider-, or healthcare system-focused interventions, the use of clinical information systems, and the measurement and management of outcomes.Consistent use of this definition and adequate documentation of the component interventions of chronic disease management will enable comparisons among programs and outcomes in evaluation research and clinical practice. Most importantly, it will assist in determining which specific interventions or combinations thereof, implemented as part of chronic disease management, are most effective.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Diabetes mellitus is the seventh leading cause of death (sixth leading cause of death by disease) in the US. Approximately 5.9% of the US population has diabetes and one-third of those with diabetes are unaware that they have the condition. Diabetes is the leading cause of adult blindness, end-stage renal disease, and non-traumatic lower extremity amputation.The annual per-capita incremental cost of diabetes among employees compared with individuals without diabetes has been estimated at $US4410 (1998 values). Furthermore, more than 30% of the costs associated with diabetic employees are attributable to medically related work absences and disability, and this is estimated to cause a one-third reduction in earnings due to reduced workforce participation.The incidence of diabetes and long term medical complications could be reduced through more effective diabetes education and patient self-management. Intensive management of diabetes can help workers remain productive, decrease costs associated with complications, and reduce associated costs for overtime. Policy complications from this review encourage employers and Medicare/Medicaid to invest in diabetes education and wellness programs.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

We describe a health plan-based herbal resource program designed within the framework of a systems approach to population health improvement. The setting is a not-for-profit, consumer-governed health plan in the Midwestern US. Telephone-based, centralized services facilitate a process of access, communication, documentation and intervention in the area of complementary and alternative medicine (CAM) use. A herbal-trained resource pharmacist is employed to provide evidence-based information on CAM products, when available, to patients and healthcare providers, educate patients who have chosen to self-medicate with CAM products for chronic conditions, and assist patients in the selection of quality CAM products prescribed by a physician. Three case studies are presented as examples of how the program is accessed, the intervention is tailored to individual needs, communication is established, documentation is organized and support is facilitated.In the year 2002, of the 61 860 contacts/encounters to the phone line, 1190 were with the herbal resource pharmacist. Of these, 68% were with patients and 31% with healthcare providers. Satisfaction of patients utilizing this resource appears to be high, with 60% rating the service as exceeding their expectations, 96% indicating they would refer the service to an acquaintance, and 100% of those surveyed indicating they improved their understanding of use and safety of herbal medicine and other natural products.An herbal resource support program appears to effectively provide access to timely information for both patients and providers. This approach, designed to meet the CAM information needs of both patients and providers, appears well positioned within the context of a health plan as the service is supportive to all users.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Older patients often experience a loss of independent physical functioning during the course of an acute illness that requires hospitalization. Although functional outcomes are not usually the focus of care in the hospital, they may be critical determinants of the quality of life, physical independence, cost of care, and prognosis among older patients.Based on a conceptual model of the dysfunctional syndrome (functional decline associated with hospitalization) we developed, implemented and evaluated a multi-component intervention termed Acute Care for Elders (ACE), in hospital medical units of two urban hospitals. ACE is a model of care that combines the principles of geriatric assessment and quality improvement. The ACE intervention includes a prepared environment (environmental modification), patient-centered care (interdisciplinary assessment), interdisciplinary team rounds and planning for home, and medical care review. Results of randomized clinical trials support the effectiveness of ACE to improve outcomes of hospitalization for older patients. Improved functional status, lower risk of nursing home placement and higher levels of patient and professional satisfaction with care are achievable with ACE. The challenges of establishing an ACE unit in community hospitals can be met through a systematic process of implementation and evaluation.ACE is a multi-component intervention that is potentially transportable to other hospital units, with benefits for patients, health professionals and hospital administrators.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

This article reviews the value of myoglobin, troponins, and creatine kinase, MB fraction (CK-MB) in diagnosis, risk stratification, and prognosis in patients presenting to hospital emergency departments (ED) with symptoms suggestive of acute coronary syndromes. Because the three markers differ in specificities and their sensitivities vary with time after the onset of chest pain, the authors suggest that serial measurements for all three markers by point-of-care methods will optimize patient outcomes and reduce resource utilization. The rationale for this strategy is examined from the viewpoint of ED physicians who must make diagnoses, risk stratify patients, and make treatment decisions in patients presenting with non-diagnostic ECGs.The articles reviewed show that despite its elevation in renal and skeletal muscle disease, myoglobin offers more sensitivity for the early diagnosis of acute myocardial infarction (MI) than either CK-MB or troponins. The most important characteristic of myoglobin is its high negative predictive value for acute MI. Myoglobin also shows promise as a non-invasive marker of reperfusion status in patients undergoing thrombolytic therapy.Articles are examined which indicate that cardiac troponin I and troponin T, despite standardization problems for troponin I, offer greater specificity than either CK-MB or myoglobin in detecting MI, particularly when measurements are made with third-generation assays at presentation and 6–12 hours later. Because troponin elevation persists for days after CK-MB and myoglobin have returned to normal, troponins have high sensitivity for detecting MIs in patients presenting days after the onset of chest pain.The use of troponins in evaluating prognosis in patients with acute coronary syndromes – including those at low risk for MI, without ECG changes, triaged to a chest pain unit, with renal disease, undergoing noncardiac surgery, and undergoing treatment for MI – is discussed in detail because troponin concentrations may help to guide ED clinicians in diagnosis, risk stratification, and treatment.Finally, key reports suggesting that rapid serial measurements of myoglobin, troponin, and CK-MB may improve patient outcomes and conserve hospital resources compared with laboratory-based testing are examined in detail.Measurements of troponin, myoglobin, and CK-MB are useful in emergency care settings. Point-of-care tests are easy to perform and provide results rapidly enough to permit the use of marker concentrations in diagnosis and risk stratification. They offer an opportunity for clinicians to initiate prompt and aggressive treatments only when necessary, thus conserving hospital resources.

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