摘要:

Although Medicare risk plans have been withdrawn in a number of US geographical areas, the size and dollar value associated with the senior demographic group is too large for health plans to ignore.Unlike other developed nations, the US government offers to Medicare-eligible citizens a choice between payment methods for health services. The fee-for-service reimbursement system (Medicare Parts A and B) has been in effect for 30 years; capitated prepaid Medicare risk plans (Medicare+Choice), the subject of this article, are a more recent addition. Active discussion has emerged on how best to pursue disease management in the Medicare risk environment.Disease management must constructively address comorbidities and realise bottom-line medical management savings. With limited medical management resources and a requirement for near-term results, successful programmes will anticipate and concentrate on the tiny fraction of members who generate a large portion of costs.In the future, health plans will make use of the Internet to share essential information across fragmented delivery systems and individually engage seniors, who are increasingly on-line, in their care.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Individuals with diabetes mellitus and their providers view the world from their own perspectives and bring these different perspectives to the clinical encounter. Because individuals with diabetes enact the day-to-day management of their disease, their perspective will, therefore, largely determine their behaviours.A broad interpretation of how to think about individuals in their patient role, their social context and their relationships with providers creates opportunities for providers to assist patients in life-enhancing ways. Steps for providers include examining their own values and attitudes about diabetes and its treatment, contextualising patient responses and incorporating a different set of questions in the clinical encounter. Steps for organisations include involving patients in interdisciplinary meetings, evaluation of system and provider quality, creating a milieu which supports dialogue and relationship development, important elements of a caring environment.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Noncompliance is a major problem in antihypertensive treatment. Up to 50% of patients are noncompliant after 1 year and 85% after 5 years. Current approaches for predicting compliance are based on patient demographics, medication characteristics and clinical factors, health beliefs and the quality of patient-provider communication. All of these factors together predict compliance only less than half the time, indicating that over half of the patients in disease management programmes may not buy-in to their treatment.A new approach views compliance as behaviour change that takes place over time. Patients move through 5 stages in their ‘readiness to comply’. Our study of over 700 patients with hypertension using brief self-report measures to assess their ‘readiness to comply’ found a highly significant relationship between ‘readiness to comply’ and reported compliance. Clinicians can increase patient buy-in and long term compliance by assessing their patients ‘stage-of-change’ using validated measures and then matching their interventions to each patient's ‘readiness to comply’.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

‘Health and disease management’ is a clinical improvement process aimed at ensuring that the best practices known to medical science are incorporated with minimal variation over the entire continuum of care. The University of Pennsylvania Health System (UPHS) is an academic, integrated healthcare delivery system committed to implementing this approach to care by all providers and at all sites. This report outlines our approach to design, implementation, outcomes tracking and improvement, and highlights how the educational, service and research missions of the academic health system add value to the comprehensive health and disease management approach.The involvement of clinical researchers and academic physicians in the design of programmes contributes directly to improved clinical outcomes. Faculty with specific research interests, and experience with less common conditions, frequently lead this best-practice approach with rarer conditions, so allowing the impact of these programmes on improving the quality of care to be evaluated across many disease states. On the basis of their extensive knowledge of the disease in question, academic faculty play valuable leadership roles in selecting relevant key measures.Education, a key component of health and disease management implementation, is an area of particular strength in academic systems. Provider education, in particular, can be effectively achieved by academic detailing, led by specialists and utilising the involvement of skilled educators.A key requirement for programmes such as these is the need to frequently update the best-practice clinical guidelines. The academic health system is ideally poised to rapidly incorporate clinical advance and emerging knowledge into disease management programmes that can reach a wide audience. Health and disease management offers a unique research opportunity for academic physicians who can adapt the use of process control measurement techniques, which have long been the major approach to performance measurement in industry, to the healthcare environment.Clinical evaluation and outcomes management, has the potential to become widely embraced as a legitimate and important form of research. Substantial effort and resources must be dedicated to gain provider buy-in and achieve compliance. We believe that academic health systems have many of the necessary ingredients to be successful in this initiative. Moreover, if this approach to care is to be widely adopted, and behaviour change achieved, the next generation of healthcare leaders and workers must be introduced to these concepts early in their training.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Although process measures of care have traditionally been used to assess the quality of healthcare, there is little evidence, for the majority of healthcare activities, to support a clear relationship between processes of care and resulting health gains. Outcomes monitoring is increasingly being advocated as a vital component of healthcare, particularly with the increasingly aging population. A consensus is emerging that routine systems of outcome monitoring are fundamental to rational clinical decision-making and public policy.There are several issues that need to be considered when implementing a routine system of outcome monitoring; this article addresses these issues in older people within a UK community setting in the context of an innovative observational feasibility study (The North East Fife Outcomes Project). This projectdetermined which outcomes of health and social care are the most important to this patient group; andidentified appropriate measures for relevant outcomes suitable for use in a community setting.Key patient characteristics and relevant clinical and social care process variables were then recorded, concomitant variables such as disease severity and comorbidities were taken into account and quality-of-life assessment measures recorded. For the success of any outcomes monitoring system, feedback to end-users is important. The North East Fife Project will assess the feasibility and value of feedback at the individual patient level and at the aggregate level.More research, particularly from large observational studies, is needed to address reliability and validity issues, biases and inaccuracies with routinely collected data and to further determine the value of routine outcomes monitoring.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS