摘要:

Disease management emphasizes prevention of disease-related exacerbations and complications using evidence-based guidelines and patient empowerment tools. It can help manage and improve the health status of a defined patient population over the entire course of a disease.More than 20 states in the US are developing and implementing Medicaid disease management programs. While most are in an early stage of development, a small number of states were pioneers in disease management and have already gained much insight. Among them, three states – Florida, Virginia, and West Virginia – provide some significant lessons.In the late 1990s, Florida’s Medicaid agency authorized development of disease management programs for patients with asthma, diabetes mellitus, HIV/AIDS, hemophilia, hypertension, cancer, end-stage renal disease, congestive heart failure, and sickle cell anemia. However, an analysis of results in 2001 showed significant problems (e.g. inefficiency, inconsistent care, a failure to address problems of patients with multiple diseases). These problems likely resulted from Florida trying to implement too many programs at once, using contracts with multiple vendors.The Virginia Health Outcomes Project was shown to be effective in reducing use of emergency and urgent care services by Medicaid patients with asthma (average 42% reduction in the third to fifth quarters after introduction of the program) and increasing the appropriate use of asthma medications. It was also shown to be cost effective, with projected direct savings to Medicaid of $US3–5 (2002 values) for every incremental dollar spent providing disease management support to physicians.The goals of the West Virginia Health Initiatives Project were to deliver quality care, improve health status and quality of life, and ensure the efficient and appropriate utilization of resources for Medicaid patients with diabetes. The model program had two critical components:adaptation of clinical treatment guidelines that are in the public domain to blend the highest quality of care with the best practical management strategies; andfeedback reports that provide real-time data about patients’ utilization of services to all providers involved in their care.Participating physicians and other providers received training and reimbursement for their efforts to comply with guidelines.It would be a mistake to attempt to draw firm conclusions about disease management programs for low-income elderly or physically disabled patients in the US Medicaid program given their current stage of development. However, credit should be given to the states that are experimenting with cutting-edge programs to tackle not only their fiscal issues, but perhaps more importantly, the issue of ensuring high-quality, cost-effective healthcare for the patients they serve.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

As people live longer, chronic illness care will consume an ever-larger part of a nation's financial resources. With the ‘baby-boomer’ generation reaching retirement age beginning in 2011, there will be an increased demand for chronic services/care in the population aged 65 years and older. Innovative approaches to quality care must be sought, while understanding the financial costs associated with the delivery of such care to the geriatric population. Elderly persons utilize more physical resources and it is important to identify early those beneficiaries who would benefit medically from intervention.Disease management is built on a model of integrated care, with each member of the healthcare team working together toward a common set of objectives. The ultimate goal is to keep the patient functioning well in an outpatient setting, thus avoiding the high debility and costs associated with hospitalization and institutionalization. Creating such a system requires a substantial investment in infrastructure. The concept of ‘spending $5.00 to save $10.00’ must be incorporated into the planning process. In chronically ill seniors there is a need for care as well as cure, which involves improving function and quality of life (QOL) for the frail elders by paying attention to the psychological and socioeconomic status in addition to the physical condition. Small gains in function can mean large gains in patients’ QOL. Reducing the progression of functional decline among the physically frail who live at home is a goal. Home visits are a critical component of the total care delivered.Changing physician behavior to accept the tenets of disease management requires education in advance of launching such a program. There must be healthcare team buy-in for a program to achieve success. Personnel requirements include senior nurses, social workers, physical therapists and nutritionists, supported by a sophisticated information technology system. Components of an information technology system must allow for adequate data collection and subsequent generation of reports. Continuous quality improvement will occur only if such a system is in place.While the average chronologic age of the patient with end-stage renal disease (ESRD) is almost 62 years, the physiologic age is much older. Therefore, ESRD serves as a model for chronic illness that affects a geriatric population and the benefits achieved by a disease management approach to this chronic disease are noted.Disease management improved glycemic control in the ESRD patient with diabetes mellitus by establishing a protocol for frequency of measurement of glycosylated hemoglobin (HgbA1c). For this population at risk, a decreased hospitalization rate for diabetic complications resulted from this initiative. Also, a vascular access initiative in the described ESRD disease management program resulted in an increase in the creation of arterio-venous fistulas and a decrease in the placement of tunneled-cuff catheters. Fistula creation was associated with less infections and access thrombosis compared with catheter use for access. QOL improved for these patients with ESRD because of decreased hospitalization rate for access-related issues. Significant cost savings were achieved because of fewer hospital admissions and a decrease in the number of bed days per year.The lessons learned from the ESRD model can help in developing future disease management programs for the geriatric population.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Why should depression screening be conducted in chronically ill populations? Depression is a disabling illness and is very common among patients who have chronic illnesses. Despite its high prevalence in this patient population, depression often goes unrecognized. Having a plan for a population-based screening program for depression can not only identify patients who are at risk of depression, but can also help to foster early treatment and enhanced care for these patients. This article provides an overview of commonly-used depression screening tools and presents an example of how this might be carried out in a healthcare organization.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Migraine is a common neurological disorder that remains under-recognized, under-diagnosed and under-treated. The disorder imposes a large burden on individuals and the wider community in terms of migraine-related disability and high healthcare and societal costs. Moreover, there is a discrepancy between the availability of effective pharmacologic intervention and the level of treatment that patients with migraine actually receive. A disease management program can benefit individuals with migraine and society in general, by delivering improved care within a cost-effective framework.Disease management programs aim to reduce the burden of illness by identifying key factors that influence disease outcome. Herein, we consider a clinic-based migraine disease management program. Currently, step care remains the most common approach to migraine management. However, this approach frequently delays effective therapy and leads to patient dissatisfaction and lapse from medical care. Stratified care is an alternative approach to migraine management and tailors the choice of therapy to the individual treatment needs of patients. The Migraine Disability Assessment (MIDAS) Questionnaire offers a simple and reliable measure of migraine-related disability. It assesses the overall impact of disease and reflects illness severity and thereby helps guide the physician to the appropriate treatment.Implementation of stratified care, based on illness severity assessed by a disability measure, increases the likelihood that patients with migraine will receive the appropriate treatment plan from the initial consultation. In a randomized trial, step-care and stratified-care approaches were compared using aspirin (acetylsalicylic acid) plus metoclopramide or zolmitriptan 2.5mg oral tablet for the treatment of migraine attacks. The study demonstrated that stratified care produced significantly better clinical outcomes and improved the cost effectiveness of healthcare delivery for migraine compared with step care strategies.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

ObjectiveTo examine the ability of various models to prospectively identify a small group of individuals with predictable high future costs that may be mitigated through disease management.Data SourcesDiagnoses and medical costs for over a million members of employer-sponsored benefit plans from the Medstat MarketScan®Research Database (1997–1999).Study DesignA prior cost model, a diagnosis-based (diagnostic cost group [DCG]) model and a diagnosis + prior cost (combo) model were each calibrated on 1997–1998 data and applied to 1998 data to identify 0.5%-sized ‘top groups’ of individuals most likely to be expensive in 1999 (validation). An individual with a year 2 cost over $US10 000 was considered to be a ‘good pick’. The percentage of good picks, other features of the cost distribution, and the prevalence of ‘manageable’ i.e. commonly managed disease (diabetes mellitus, congestive heart failure, asthma/chronic obstructive pulmonary disease and depression) were compared in the three top groups. The performance of nine additional top groups – one for each model type fitted to costs top coded at each of $US100 000, $US50 000 and $US25 000 – was also investigated.ResultsIndividual R2values for the (full-range) prior cost, DCG, and combo models were 11, 16, and 21%, respectively; R2values increased to 27% and 31% for DCG and combo models top coded at $US25 000. The full-range model top groups contained 54, 62, and 70% good picks, and 42, 53, and 48% of their cases, respectively, had at least one manageable disease. Top coding the prior cost model did not produce better top groups. However, the top groups from the DCG and combo models top coded at $US25 000 contained the most good picks (65 and 76%, respectively) and commonly managed chronic conditions (61 and 47%, respectively).ConclusionThe DCG and combo models were better than the prior cost model for identifying groups rich in individuals who will be expensive the following year. Surprisingly, top groups based on top-coded models dominated their full-range model analogs, identifying more good picks and more people with manageable disease.

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 Weekly.1The 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