Disease Management : Dm最新文献

As financial, social, and quality-of-life challenges associated with chronic disease in the United States continue to proliferate, disease management (DM) has been identified as a viable and positive approach that serves all areas of impact. Using an "in-house" model, Physician Health Partners, LLC, designed, developed, and implemented a DM program for the frail and elderly population. Given the special needs of this population the typical DM intervention was modified to include elements of physician involvement. The Frail and Elderly Program, as the DM program is called, produced statistically significant improvements in functional, behavioral, and clinical status and health-related quality of life. This model can help result in program success with potential benefits for individuals, practices, communities, and all whose lives are touched, directly or indirectly, by chronic disease.

Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p < 0.0001). During the following 6 months, the GC group had lower unadjusted mean insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population.

Historically, health plans and disease management companies have employed "opt-out" strategies for evaluating medical management outcomes across larger populations, targeting the entire population of eligible individuals and allowing those not interested to opt out. Recent observations that the predominant effort of these programs is on high-risk patients has lead some managers to suggest that the focus be on only those individuals with an anticipated higher effectiveness and lower cost to the payers of such services. They believe such "opt-in" models, in which only higher risk participants are targeted and enrolled, will deliver higher value. The use of common opt-in models, however, is not only methodologically unsound, but experience in the field suggests there may be less overall effect as well. Calculation methods for developing impact remain extremely sensitive to methodology

Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical manufacturers, managed care organizations, and pharmacy benefit management firms. While cost containment realizations for many such interventions have been less than anticipated, this article explores potentials in marrying Medication Error Risk Reduction into DM programs within managed care environments. Medication errors are an emergent serious problem now gaining attention in US health policy. They represent a failure within population-based health programs because they remain significant cost drivers. Therefore, medication errors should be addressed in an organized fashion, with DM being a worthy candidate for piggybacking such programs to achieve the best synergistic effects.

This study examined the risk for avoidable diabetes hospitalizations associated with comorbid conditions and other risk variables. A retrospective analysis was conducted of hospitalizations with a primary diagnosis of diabetes in a 2004 sample of short stay general hospitals in the United States (N = 97,526.) Data were drawn from the Health Care Utilization Project National Inpatient Sample. Avoidable hospitalizations were defined using criteria from the Agency for Healthcare Research and Quality to analyze 2 types of ambulatory care sensitive conditions (ACSCs): short-term complications and uncontrolled diabetes. Maternal cases, patients younger than age 18, and transfers from other hospitals were excluded. Avoidable hospitalization was estimated using maximum likelihood logistic regression analysis, where independent variables included patient age, gender, comorbidities, uninsurance status, patient's rural-urban residence and income estimate, and hospital variables. Models were identified using multiple runs on 3 random quartiles and validated using the fourth quartile. Costs were estimated from charge data using cost-to-charge ratios. Results indicated that these 2 ACSCs accounted for 35,312 or 36% of all diabetes hospitalizations. Multiple types of comorbid conditions were related to risk for avoidable diabetes hospitalizations. Estimated costs and length of stay were lower among these types of avoidable hospitalizations compared to other diabetes hospitalizations; however, total estimated nationwide costs for 2004 short-term complications and uncontrolled diabetes hospitalizations totaled over $1.3 billion. Recommendations are made for how disease management programs for diabetes could incorporate treatment for comorbid conditions to reduce hospitalization risk.