摘要:

There is a growing interest in the US among payors, purchasers of healthcare benefits, providers, policy-makers and the public in the promise of disease management or disease-specific care. While there have been early efforts to standardize the application and measurement of disease-specific care programs, no national standards or uniform performance measurement specifications existed prior to 2002. The Joint Commission on Accreditation of Healthcare Organizations (Illinois, USA) published its national standards and conducted its first certification evaluation for disease-specific care in February 2002. The Disease-Specific Care (DSC) Certification Program is fundamentally based on an evaluation of a disease-specific care program’s compliance with the Joint Commission’s standards, implementation of adherence to clinical practice guidelines and its outcomes of care. Organizations that have achieved Joint Commission DSC Certification have reported impressive results from their performance measurement and improvement activities.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The recent implementation of the Model for End-stage Liver Disease (MELD)/Pediatric End-stage Liver Disease (PELD) system for the allocation of cadaveric liver organs in the US represents a dramatic change in organ allocation policy. Previous allocation algorithms used a categorical stratification system, in which candidates were ranked by the length of time waiting within these strata. This resulted in the ranking of patients by time waiting on the list, not by their need for a transplant. Moreover, these previous systems had not been validated for their accuracy in predicting the severity of liver disease and did not meet the needs of the enlarging population of appropriate candidates with end-stage liver disease. The MELD was identified as a potentially more accurate measure of liver disease, and a new plan for liver allocation incorporating the MELD score and virtually eliminating waiting time was devised. Several diagnoses for which liver transplantation is indicated were identified as not being served by the MELD system, so alternative mechanisms were developed for these cases. The new allocation system went into effect on February 27, 2002. One year after implementation, there was a statistically significant increase in the number of cadaveric transplants and a slight reduction in the number of waiting list deaths compared with the previous system in the year prior to MELD.As the system evolves and improvements are made, patients have a much more objective measure of the severity of their liver disease, which is comparable regardless of the geographic location or physician. This change to a mathematically-based system that defines the risk of death represents a change in the way patients and caregivers will think about the liver transplant list. In addition, payors now have a much more objective measure of the severity of illness and can more accurately risk-adjust their comparisons of centers and patients. The new system directs organs to sicker patients, and waiting candidates are likely to experience significant declines in their quality of life while waiting. In addition, because this new policy will result in more severely ill patients receiving transplants, the costs of care are likely to increase, although preliminary results suggest that survival rates have not changed. The change to this new, more evidence-based system is a significant paradigm shift in organ allocation policy. Patients, caregivers, and payors should also be prepared for continuous evolution of the system as more data become available.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The literature contains a number of reports of early work involving telemedicine and chronic disease; however, there are comparatively few studies in asthma. Most of the telemedicine studies in asthma have investigated the use of remote monitoring of patients in the home, e.g. transmitting spirometry data via a telephone modem to a central server. The primary objective of these studies was to improve management. A secondary benefit was that patient adherence to prescribed treatment is also likely to be improved. Early results are encouraging; home monitoring in a randomized controlled trial in Japan significantly reduced the number of emergency room visits by patients with poorly controlled asthma. Other studies have described the cost-benefits of a specialist asthma nurse who can manage patients by telephone contact, as well as deliver asthma education. Many web-based systems are available for the general public or healthcare professionals to improve education in asthma, although their quality is highly variable.The work on telemedicine in asthma clearly shows that the technique holds promise in a number of areas. Unfortunately – as in telemedicine generally – most of the literature in patients with asthma refers to pilot trials and feasibility studies, with short-term outcomes. Large-scale, formal research trials are required to establish the cost effectiveness of telemedicine in asthma.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

In this article, we review the reduction in healthcare costs associated with a health maintenance organization (HMO)-sponsored diabetes disease management program in Pennsylvania, USA. The program emphasizes primary care-based nurse education and case management of patients with diabetes mellitus. We found participants in the program experienced a slight increase in health insurance claims related to diabetes care but a notable decrease in total healthcare claims, with a return on investment that exceeded $US3 saved for every dollar expended. The changes we observed appeared within a year of program entry, and were sustained on a month-to-month basis.Other potential competitive advantages for our HMO created by our disease management programs include a decreased variation in month-to-month costs, greater physician loyalty, and greater local marketplace recognition of quality.While further studies are necessary to truly gauge the overall value of disease management, our data suggest disease management is an important consideration for health insurance companies faced with increasing costs among enrollees with diabetes mellitus.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

In view of sweeping health and human service reforms around the US and abroad, program performance standards, their measurement, and their application in program accountability have become critical functions. Measuring the performance of healthcare systems has added a new dimension to the evaluation and management of acute care. Multiple-level evaluation approaches – including randomized controlled trials, cohort, case control and retrospective studies, economic modeling and cost-effectiveness analyses, and case studies – will be necessary to persuade diverse groups of stakeholders, particularly when the interventions are multi-faceted. The goal of multi-level evaluation approaches is to develop an internally consistent set of findings that produce a preponderance of evidence in support of a particular management strategy. Such an approach should also eliminate alternative explanations.The management of certain infectious diseases such as pulmonary tuberculosis (TB) has refocused the attention of performance evaluators upon the concept of continuum of care. Multiple-level evaluation approaches consistently underscore a case management approach based on the use of comprehensive, community-based, patient-centered directly observed therapy (DOT) programs for achieving the highest treatment completion rates for patients with pulmonary TB.As lengths of stays in hospitals continue to shorten, it has become apparent that clinical outcomes cannot be measured during the hospitalization episode(s) alone. This paper discusses the evidence-based case management of pulmonary TB, concluding that patient-centered approaches involving DOT provide the most effective care and disease prevention. Health and public healthcare systems should adopt such patient-centered approaches when managing resurgent infectious diseases such as pulmonary TB.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Scarce resources are dedicated to research on school-based prevention programs for eating disorders. Despite this, however, recent years have witnessed an abundance of publications on controlled prevention trials. We now have a cumulative body of knowledge available to guide future developments in the prevention of eating disorders.Medline and PsychInfo were searched for the years 1985–2002 to find relevant publications for this review. Nineteen universal and ten targeted school-based prevention programs were identified and then evaluated.The results obtained by the controlled trials evaluated reassure parents, teachers, and stakeholders in the healthcare sector that school-based eating disorder prevention programs do not have harmful effects on student attitudes and behaviors. Targeted prevention programs have obtained promising results in high-risk individuals. Other positive effects have been obtained using an interactive format. Universal prevention programs have unfortunately been disappointing in their ability to change unhealthy behaviors.Results can be improved by gaining a greater understanding of those risk factors which are most strongly linked to eating disorders and most susceptible to change. A broad range of interventions is needed for further consideration. Promising results from the field of eating disorder prevention and from modern risk factor research could build a new generation of universal prevention trials for eating disorders without the methodological limitations seen in the current literature and with real effectiveness in achieving the goal of reducing the prevalence of eating disorders in the general population.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

ObjectiveTo assess the predictive validity of the pneumonia severity-of-illness index (PSI), a mortality prediction rule, and extend the work of others by including data on outpatients treated for pneumonia.MethodsProspective study of 675 consecutive patients with community-acquired pneumonia (CAP) [501 inpatients and 174 outpatients] treated at primary care practice clinics or emergency departments at nine medical centers (five community healthcare systems, three university-affiliated hospital systems, and one Veterans Affairs Medical Center) in Georgia and Virginia in the US between November 1996 and March 1998. Data, including demographic characteristics, co-morbid conditions, laboratory and chest x-ray results, were collected from surveys administered to patients at inception, 2, 15, and 30 days and from retrospective medical chart review. We computed the PSI for each patient using demographic and prognostic factors including age, gender, co-existing illnesses, vital signs, laboratory test results and the corresponding logistic regression parameters from previous research. In addition, the Pneumonia Outcomes Research Team (PORT) prediction rule was used to risk adjust patients for mortality severity by disposition.ResultsThe PSI performed well in its ability to predict mortality for our sample of patients with an area under the Receiver Operating Curve (ROC) of 0.757, significantly different than chance (p < 0.01). Results of the Homser and Lemeshow goodness of fit test also indicated that the PSI was a reasonably good predictor of mortality for our patients. Twenty-eight patients (4.1%) died within the 30-day observation period. Using the PORT prediction rule we found that 27 of the deaths occurred among inpatients (three in class II, five in class III and 19 in class IV). One of these deaths occurred among outpatients (risk class IV).ConclusionThe PSI is a valid predictor of mortality for outpatients and inpatients treated in various community-based settings.

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