摘要:

The rapid increase in telemedicine technologies has increased the demand for assessment studies to inform decision makers as to how feasible, efficient, effective, cost effective and/or cost saving the new technology is compared with a conventional alternative. In this article, we considered the main methods used for health technology assessment studies in the field of telemedicine, the types of outcome that are evaluated, and the application of the general assessment framework to the field of telemedicine.Studies of telemedicine may consider technical outcomes, feasibility of applications, surrogate or actual clinical measures, health-related quality of life (HR-QOL), and economic issues. To date, only a few studies have measured clinical outcomes or HR-QOL to show the outcomes of telemedicine compared with a conventional alternative. In economic analyses of telemedicine, many studies are simply cost descriptions, that is, costs of the telemedicine alternative are shown. For decision-making purposes cost-effectiveness and cost-benefit analyses would provide much better information.The differences in healthcare systems between countries as well as the differences in costs and reimbursement methods make the decision-making process challenging. To reduce the burden in the decision-making process, it is recommended that the local conditions influencing results should be presented in studies. Sensitivity analysis can be used to show the changes in the results when the background variables in the decision-making process are changed.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Over the past several years, the healthcare industry has been struggling as a whole for effective ways to manage chronic disease and illness. In the US and in countries with socialized medicine, healthcare has either been rationed, restricted or had access limited to various healthcare services via traditional resource utilization approaches. In the US, utilization management approaches practiced by healthcare insurance companies, primarily Health Maintenance Organizations (HMOs), has suffered through a barrage of legal and regulatory hurdles as a result of consumer backlash to such restrictive programs. Thus, greater emphasis on case and disease management programs has emerged as a more progressive means for improving health outcomes in the chronically ill population.A challenge confronting facilitators of these programs is the ability to integrate various case and disease management modalities into a seamless care management model that will yield optimal patient outcome opportunities. Case/disease management (CDM) can be best summarized as an ‘integrated’ approach to managing healthcare that identifies the optimal treatment approaches for patients with a specific disease and implements processes to afford compassionate and clinically evidenced-based care that will prevent disease complications and improve the health and quality of life of a given patient or patient population. However, depending on the facilitator of these programs (insurer, employer, independent vendor of services), CDM can have many different meanings and will vary in the scope, specificity and intensity of programs provided, as well as the level and extent of its major components.An integrated program involves many considerations, such as: how an organization defines CDM and its true objectives, whether an effective infrastructure is in place to support it, what barriers exist that could potentially impede the program's success, having the right technology to support outcome measurement and developing collaborative partnerships with providers, vendors and purchasers to streamline program costs and improve overall efficiency.A description of the differences and similarities in CM and DM programs is given, including each program's major components and how these models could evolve into a more integrated healthcare model. An overview of the most common care barriers is emphasized, affording careful consideration to healthcare design and how the current delivery system should be remodeled. A discussion of the utility and challenges of outcome management is put forth in order to aid CDM facilitators and other healthcare providers in futuristic outcomes planning and implementation.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

The monitoring of vital signs is a basic task that has been carried out on patients that are admitted into specialized units, such as coronary care units, intensive care units and operating rooms. There is now a good deal of interest in the ever-increasing possibility of such monitoring being extended further, outside the hospital setting (e.g. to the patient's home). We point out some of the aspects that have most significantly affected the evolution of monitoring systems, and identify some of the most important lines of research and improvement: endowing systems with greater intelligence (conditioned to a good degree by considerable advances at the level of sub-symbolic processing); the introduction of standards for the representation and transmission of monitoring information; ubiquity, in both the possibility of monitoring patients in any location and situation, and the capability of accessing this monitoring information. We end by presenting a line of research into intelligent ubiquitous monitoring developed by the authors.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Multiple sclerosis (MS) is a chronic neurological disease of adults that affects over 1 million people worldwide. Relapsing-remitting MS, characterized by acute attacks (relapses) followed by complete or partial remissions, is the most common type of MS at disease onset. Over time, most patients develop secondary-progressive disease. Costs for patients, caregivers, healthcare providers and insurers, and society in general are high because of the progressive disability and long-term care associated with MS. Historically, drug therapy has represented a relatively small component of the overall cost of the disease and indirect costs have accounted for most of the costs. Although not curative, disease-modifying agents are available for first-line use in patients with relapsing-remitting MS; the goals of therapy are to reduce the frequency and severity of relapses and postpone disease progression. All of the disease-modifying agents are associated with high cost-utility ratios.Subcutaneous (SC) interferon-β-1a (Rebif®1) is a disease-modifying therapy that demonstrates significant benefits on all outcome measures of clinical trials [relapse rate, relapse severity, progression of disability, magnetic resonance imaging (MRI) burden of disease and MRI activity] in patients with relapsing-remitting MS. In a large, 2-year, double-blind trial, SC interferon-β-1a 44μg three time weekly decreased the number of relapses by 32% and delayed disease progression by 9.4 months with compared with placebo. In addition, patients treated with SC interferon-β-1a had 78% fewer active lesions than placebo recipients when evaluated by MRI scans. A 2-year extension of this trial demonstrated the persistence of positive effects with treatment.Results from a large, assessor-blinded, randomized trial in patients with relapsing-remitting MS show a significant short-term therapeutic advantage for SC interferon-β-1a over IM interferon-β-1a. At week 24 of treatment, 74.9% of patients who received SC interferon-β-1a 44μg three times weekly were relapse-free compared with 63.3% of those who received intramuscular (IM) interferon-β-1a 30μg (Avonex®) once weekly. Moreover, there were fewer mean active lesions per MRI scan in SC interferon-β-1a recipients than in IM interferon-β-1a recipients (0.7vs1.3 lesions).The most frequently reported adverse event with SC interferon-β-1a is injection site inflammation (>60% of patients). SC interferon-β-1a treatment is associated with the well recognized adverse events which accompany interferon therapy including flu-like syndrome and dose-related effects on elevation of liver enzymes and reduction in white blood cell indices.The reduction in relapses, hospital admissions and courses of corticosteroid therapy seen with SC interferon-β-1a compared with placebo results in decreased costs within the healthcare system. The delay in disease progression may reduce both direct (e.g. paid caregivers and adaptive equipment) and indirect (e.g. disability payments and lost income) costs and will likely be distributed across multiple healthcare and non-healthcare systems.In conclusion, SC interferon-β-1a is a valuable first-line disease-modifying therapy in the treatment of patients with relapsing forms of MS. The high acquisition costs of interferon-β-1a must be weighed against the long-term benefits of therapy.

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