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Ho SC, Hsieh CJ, Lo LC, Lin JG. A suggested mortality benefit with integrated health care versus conventional home health care in Taiwan. Home Health Care Serv Q 2024; 43:1-17. [PMID: 37042246 DOI: 10.1080/01621424.2023.2195810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
In Taiwan, the Integrated Home Care (IHC) project was introduced for medically compromised patients living at home receiving Home Health Care (HHC) in 2016. The focus of the project was on organizing care teams and managing care for patients. The aim of this study was to investigate the benefits and impacts of IHC in Taiwan. The primary outcome measure was the mortality rate of patients who received IHC versus those who did not receive IHC (non-IHC). The secondary outcomes were medical utilization and expenditure. The results showed that IHC was associated with a statistically significant reduction in mortality compared to non-IHC for home-dwelling patients over 90-, 180-, and 365-days periods. Additionally, IHC users were less likely to be hospitalized and had shorter hospitalization times compared to non-IHC users. Furthermore, IHC was found to reduce medical expenditure compared to non-IHC.
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Affiliation(s)
- Shao-Chang Ho
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Taoyuan Chinese Medicine Association, Taoyuan, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Lun-Chien Lo
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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2
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AlHabeeb W. Heart failure disease management program: A review. Medicine (Baltimore) 2022; 101:e29805. [PMID: 35945723 PMCID: PMC9351896 DOI: 10.1097/md.0000000000029805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment. The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Waleed AlHabeeb, P.O. Box 2925, Riyadh 11461, Saudi Arabia (e-mail: )
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Brunn M. Born in the USA? A Comparison of "Inspired" Health Care Reforms in Germany and France. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:27-61. [PMID: 34280255 DOI: 10.1215/03616878-9417442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CONTEXT Despite numerous examples of health policy transfer in Western health systems, the nature of such "inspired" reforms has received little detailed attention. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms using the theoretical frameworks of transfer and translation. METHODS The design is based on a comparative case study: the introduction of disease management programs (DMPs) for diabetes in Germany in 2002 and in France in 2008, drawing on a literature review and semistructured interviews. FINDINGS In introducing its DMP, Germany chose and combined several components in a process of selective borrowing, while France opted for copying a specific foreign program and adapting it. Such differences in process are linked to distinct system structures, in particular the setup of health insurance and the representation of physicians. Furthermore, the displayed versus actual degree of inspiration varied significantly, with a branding strategy in Germany (high display of foreign influence) and the inverse picture in France (high degree of actual inspiration). CONCLUSIONS This analysis has applied the dual perspective of transfer and translation. Both perspectives proved complementary and necessary, and translation appeared as a main determinant of implementation success.
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Thomson J, Hall M, Nelson K, Flores JC, Garrity B, DeCourcey DD, Agrawal R, Goodman DM, Feinstein JA, Coller RJ, Cohen E, Kuo DZ, Antoon JW, Houtrow AJ, Bastianelli L, Berry JG. Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment. Pediatrics 2021; 147:e2020009217. [PMID: 33414236 PMCID: PMC7849195 DOI: 10.1542/peds.2020-009217] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI. METHODS This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity. RESULTS The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7-3.8), 4.6 (95% CI 4.5-4.7), and 5.1 (95% CI 5.1-5.2). An increasing percentage of children had ≥9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years. CONCLUSIONS Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.
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Affiliation(s)
- Joanna Thomson
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio;
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Katherine Nelson
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Juan Carlos Flores
- Division of Pediatrics, Pontificia Universidad Católica de Chile and Hospital Sotero del Rio, Santiago, Chile
| | | | - Danielle D DeCourcey
- Medical Critical Care, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Rishi Agrawal
- Divisions of Hospital Based Medicine and
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Denise M Goodman
- Critical Care
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Ryan J Coller
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - James W Antoon
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Amy J Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
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5
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Vanscoy GJ. The Emergence of Specialty Pharmacy. J Manag Care Spec Pharm 2020; 26:229-233. [PMID: 32105167 PMCID: PMC10391113 DOI: 10.18553/jmcp.2020.26.3.229a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gordon J. Vanscoy
- GORDON J. VANSCOY, Pharm.D, M.B.A., is Executive Vice President and Chief Clinical Officer, Stadllanders Operating Company, LLC, and Assistant Dean of Managed Care and Associate Professor, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
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N’Dri LA, Park S, Nash DB, Park S. The Evolution of Disease State Management: Historical Milestones and Future Directions. J Manag Care Spec Pharm 2020; 26:90-93. [PMID: 32011962 PMCID: PMC10390930 DOI: 10.18553/jmcp.2020.26.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twenty-five years ago, the Journal of Managed Care Pharmacy introduced its readers to disease state management, which attempted to break the siloed culture of the U.S. health care system. Disease state management has been transformed, in part, to population health management. This shift was marked by 3 main inflection points: the rise of the web-enabled smartphone, the Patient Protection and Affordable Care Act (ACA), and the adoption of artificial intelligence (AI). The introduction of smartphones filled the communication gap through improved patient engagement and accessible mobile applications, giving patients access to their clinical data. In addition, through the ACA, bundled payment models moved away from a volume-based to a value-based payment approach and attempted to incorporate population health concerns, such as the social determinants of health. The advancement of AI will allow the health care system to collect comprehensive health data and to predict the population at higher risk. Despite these advancements, some challenges from 25 years ago remain, yet rapid technology advancements may expedite the next wave of change. DISCLOSURES: No funding contributed to the writing of this article. The authors have nothing to disclose with respect to research, authorship, and/or publication of this article.
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Affiliation(s)
- Laetitia A. N’Dri
- Health Economics & Outcomes Research (HEOR) Fellows, Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Seojin Park
- Health Economics & Outcomes Research (HEOR) Fellows, Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - David B. Nash
- Founding Dean Emeritus, Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Seojin Park
- Health Economics & Outcomes Research (HEOR) Fellows, Jefferson College of Population Health, Philadelphia, Pennsylvania
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Abstract
Objectives: To assess the respiratory syncytial virus (RSV) infection incidence rate through the analysis of data collected before and after implementation of a new palivizumab dosing regimen customized for a high-risk Saudi population. Methods: This was a retrospective cohort study performed at Prince Sultan Military Medical City, Riyadh, Saudi Arabia between November 2009 and April 2017 on 1704 high risk Saudi young children and comparing 3 palivizumab regimens: a 4-week interval dosing regimen starting in either November or mid-September and a 3-week interval dosing regimen starting in mid-September. Results: Despite a decrease in the incidence rate of RSV infection with the three-week interval regimen (3.9% versus 5.9% in seasons 1 and 9.1% in seasons 2), we did not find significant differences among the 3 groups. Conclusion: Expanded use of palivizumab in newborn children could improve outcomes, but further investigation and a careful cost analysis are required.
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Affiliation(s)
- Adel S Al Harbi
- Department of Pediatric Pulmonary Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Jacofsky DJ. Population-based contracting (population health): part II. Bone Joint J 2017; 99-B:1431-1434. [PMID: 29092980 DOI: 10.1302/0301-620x.99b11.bjj-2017-0647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/29/2017] [Indexed: 11/05/2022]
Abstract
Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4.
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Affiliation(s)
- D J Jacofsky
- The CORE Institute, 18444 N. 25th Avenue, Phoenix, Arizona, USA
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10
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Villars H, Gardette V, Perrin A, Hein C, Elmalem S, de Peretti E, Zueras A, Vellas B, Nourhashémi F. Study protocol: Randomised controlled trial to evaluate the impact of an educational programme on Alzheimer's disease patients' quality of life. ALZHEIMERS RESEARCH & THERAPY 2014; 6:66. [PMID: 25478028 PMCID: PMC4255540 DOI: 10.1186/s13195-014-0066-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022]
Abstract
Introduction Therapeutic education is expanding in the management of Alzheimer’s disease (AD) patients. Several studies have revealed a positive impact of therapeutic educational programmes on the caregiver’s burden and/or quality of life. However, to date, no study has evaluated its impact on the quality of life of the AD patient. Methods The THERAD study (THerapeutic Education in Alzheimer’s Disease) is a 12-month randomised controlled trial that started in January 2013. This paper describes the study protocol. THERAD plans to enroll 170 dyads (AD patient and caregiver) on the basis of the following criteria: patient at a mild to moderately severe stage of AD, living at home, receiving support from a family caregiver. The main outcome is the patient’s quality of life assessed by the Logsdon QoL-AD scale at 2 months, reported by the caregiver. The study is being led by geriatricians trained in therapeutic education at Toulouse University Hospital in France. To date, 107 caregiver/patient dyads have been recruited. Conclusion This is the first trial designed to assess the specific impact of a therapeutic educational programme on the AD patient’s quality of life. The final results will be available in 2015. Trial registration [ClinicalTrials.gov: NCT01796314] Registered 19 February 2013
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Affiliation(s)
- Hélène Villars
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Virginie Gardette
- Department of Epidemiology and Public Health, Adresse 37, allées Jules Guesde, Toulouse Cedex, 31073, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
| | - Amélie Perrin
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Christophe Hein
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Sophie Elmalem
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Eva de Peretti
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Audrey Zueras
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France
| | - Bruno Vellas
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
| | - Fati Nourhashémi
- Geriatric Department, University Hospital, 170 avenue de Casselardit, Toulouse Cedex, 31059, France ; Inserm U 1027, University Toulouse III, Toulouse, F-31073, France
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Abstract
Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.
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12
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Fortin M, Chouinard MC, Bouhali T, Dubois MF, Gagnon C, Bélanger M. Evaluating the integration of chronic disease prevention and management services into primary health care. BMC Health Serv Res 2013; 13:132. [PMID: 23565674 PMCID: PMC3637600 DOI: 10.1186/1472-6963-13-132] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 03/28/2013] [Indexed: 11/20/2022] Open
Abstract
Background The increasing number of patients with chronic diseases represents a challenge for health care systems. The Chronic Care Model suggests a multi-component remodelling of chronic disease services to improve patient outcomes. To meet the complex and ongoing needs of patients, chronic disease prevention and management (CDPM) has been advocated as a key feature of primary care producing better outcomes, greater effectiveness and improved access to services compared to other sectors. The objective of this study is to evaluate the adaptation and implementation of an intervention involving the integration of chronic disease prevention and management (CDPM) services into primary health care. Methods/Design The implementation of the intervention will be evaluated using descriptive qualitative methods to collect data from various stakeholders (decision-makers, primary care professionals, CDPM professionals and patients) before, during and after the implementation. The evaluation of the effects will be based on a combination of experimental designs: a randomized trial using a delayed intervention arm (n = 326), a before-and-after design with repeated measures (n = 163), and a quasi-experimental design using a comparative cohort (n = 326). This evaluation will utilize self-report questionnaires measuring self-efficacy, empowerment, comorbidity, health behaviour, functional health status, quality of life, psychological well-being, patient characteristics and co-interventions. The study will take place in eight primary care practices of the Saguenay region of Quebec (Canada). To be included, patients will have to be referred by their primary care provider and present at least one of the following conditions (or their risk factors): diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, asthma. Patients presenting serious cognitive problems will be excluded. Discussion In the short-term, improved patient self-efficacy and empowerment are expected. In the mid-term, we expect to observe an improvement in health behaviour, functional health status, quality of life and psychological well-being. At the organizational level, the project should lead to coordinated service delivery, improved patient follow-up mechanisms and enhanced interprofessional collaboration. Integration of CDPM services at the point of care in primary care practices is a promising innovation in care delivery that needs to be thoroughly evaluated. Trial registration ClinicalTrials.gov Identifier: NCT01319656
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Affiliation(s)
- Martin Fortin
- Département de médecine de famille, Université de Sherbrooke, Québec, Canada.
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Ussher M, Spatz A, Copland C, Nicolaou A, Cargill A, Amini-Tabrizi N, McCracken LM. Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. J Behav Med 2012; 37:127-34. [PMID: 23129105 DOI: 10.1007/s10865-012-9466-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
Mindfulness-based stress reduction (MBSR) has benefits for those with chronic pain. MBSR typically entails an intensive 8-week intervention. The effects of very brief mindfulness interventions are unknown. Among those with chronic pain, the immediate effects of a 10 min mindfulness-based body scan were compared with a control intervention. Fifty-five adult outpatients were randomly assigned to either: (1) mindfulness-based body scan (n = 27) or (2) a reading about natural history (control group, n = 28), provided via a 10 min audio-recording. Interventions were delivered twice across 24 h; once in the clinic and once in participants' 'normal' environment. Immediately before and after listening to the recording, participants rated pain severity, pain related distress, perceived ability for daily activities, perceived likelihood of pain interfering with social relations, and mindfulness. In the clinic, there was a significant reduction in ratings for pain related distress and for pain interfering with social relations for the body scan group compared with the control group (p = 0.005; p = 0.036, respectively). In the normal environment none of the ratings were significantly different between the groups. These data suggest that, in a clinic setting, a brief body scan has immediate benefits for those experiencing chronic pain. These benefits need to be confirmed in the field.
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Affiliation(s)
- Michael Ussher
- Division of Population Health Sciences and Education, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK,
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14
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van Oostrom SH, Picavet HSJ, van Gelder BM, Lemmens LC, Hoeymans N, van Dijk CE, Verheij RA, Schellevis FG, Baan CA. Multimorbidity and comorbidity in the Dutch population - data from general practices. BMC Public Health 2012; 12:715. [PMID: 22935268 PMCID: PMC3490727 DOI: 10.1186/1471-2458-12-715] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/10/2012] [Indexed: 12/03/2022] Open
Abstract
Background Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities. Methods We used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases. Results Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases. Conclusion Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.
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Affiliation(s)
- Sandra H van Oostrom
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven 3720 BA, the Netherlands.
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Lee D, Begley CE. Physician attitudes towards chronic disease management in the USA. Health Serv Manage Res 2012; 25:60-7. [DOI: 10.1258/hsmr.2012.011026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Whereas physician support of disease management (DM) is recognized as important for improving the quality and effectiveness of care of individuals with chronic illness, little is known about physicians’ perceptions of the model or their likelihood of adoption. A multivariate regression analysis was conducted of a 2008 nationally representative sample of practising physicians in the USA who had been exposed to DM programmes ( n = 1615) to determine their support for DM and how attitudes differ across physicians. Results indicated that the majority of physicians believe in the quality enhancing benefits of DM programmes, but there are systematic differences in the attitudes towards DM of different types of physicians. Physicians affiliated with health maintenance organizations (HMOs) and hospital-based practices are more likely than other physicians to agree that DM programmes improve their ability to provide high-quality care to patients with chronic conditions. Minority physicians and physicians who perceive their market as more competitive, have a more positive attitude towards DM than white physicians and physicians in less competitive markets. International medical graduates hold relatively positive attitudes about the benefits of DM programmes and older physicians are more likely than their young peers to approve of DM and physicians. Physicians with a higher percentage of patients with chronic conditions are more likely to have a favourable view of DM. Specialty physicians are more likely to have a positive view of DM, and DM-exposed physicians are more likely to perceive that DM programmes lead to improved quality of care. Future study is needed to determine the reasons for these differences in attitudes and whether they can be modified by targeted information.
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Affiliation(s)
- Doohee Lee
- Marshall University, College of Business, Graduate School of Management, Department of Management, Marketing, MIS, Charleston, USA
| | - Charles E. Begley
- The University of Texas School of Public Health - Management and Policy Sciences, Houston, TX, USA
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Cardosa M, Osman ZJ, Nicholas M, Tonkin L, Williams A, Abd Aziz K, Mohd Ali R, Dahari NM. Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up. Transl Behav Med 2012; 2:30-37. [PMID: 22448204 PMCID: PMC3291846 DOI: 10.1007/s13142-011-0095-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.
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Affiliation(s)
| | - Zubaidah Jamil Osman
- Department of Psychiatry, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Michael Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Lois Tonkin
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
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Sampalli T, Fox RA, Dickson R, Fox J. Proposed model of integrated care to improve health outcomes for individuals with multimorbidities. Patient Prefer Adherence 2012; 6:757-64. [PMID: 23118532 PMCID: PMC3484525 DOI: 10.2147/ppa.s35201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Indexed: 12/21/2022] Open
Abstract
Multimorbidity is defined as the coexistence of multiple chronic conditions. Individuals with multimorbidity typically present with complex needs and show significant changes in their functional health and quality of life. Multimorbidity in the aging population is well recognized, but there has been limited research on ways to manage the problem effectively. More recent studies have demonstrated a high prevalence of multimorbidity in the younger demographics aged under 65 years. There is a definite need to develop models of care that can manage these individuals effectively and mitigate the impact of illness on individuals and the financial burden to the health care system. An integrated model of care has been developed and implemented in a facility in Nova Scotia that routinely treats individuals with multiple chronic conditions. This care model is designed to address the specific needs of this complex patient population, with integrated and coordinated care modules that meet the needs of the person versus the disease. The results of a pilot evaluation of this care model are also discussed.
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Affiliation(s)
- Tara Sampalli
- Correspondence: Tara Sampalli, Integrated Chronic Care Service, Primary Health Care, Capital Health, Nova Scotia, Canada, Tel +1 902 860 3107, Fax +1 902 860 2046, Email
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Versnel N, Welschen LMC, Baan CA, Nijpels G, Schellevis FG. The effectiveness of case management for comorbid diabetes type 2 patients; the CasCo study. Design of a randomized controlled trial. BMC FAMILY PRACTICE 2011; 12:68. [PMID: 21729265 PMCID: PMC3142502 DOI: 10.1186/1471-2296-12-68] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 07/05/2011] [Indexed: 11/25/2022]
Abstract
Background More than half of the patients with type 2 diabetes (T2DM) patients are diagnosed with one or more comorbid disorders. They can participate in several single-disease oriented disease management programs, which may lead to fragmented care because these programs are not well prepared for coordinating care between programs. Comorbid patients are therefore at risk for suboptimal treatment, unsafe care, inefficient use of health care services and unnecessary costs. Case management is a possible model to counteract fragmented care for comorbid patients. It includes evidence-based optimal care, but is tailored to the individual patients' preferences. The objective of this study is to examine the effectiveness of a case management program, in addition to a diabetes management program, on the quality of care for comorbid T2DM patients. Methods/Design The study is a randomized controlled trial among patients with T2DM and at least one comorbid chronic disease (N = 230), who already participate in a diabetes management program. Randomization will take place at the level of the patients in general practices. Trained practice nurses (case managers) will apply a case management program in addition to the diabetes management program. The case management intervention is based on the Guided Care model and includes six elements; assessing health care needs, planning care, create access to other care providers and community resources, monitoring, coordinating care and recording of all relevant information. Patients in the control group will continue their participation in the diabetes management program and receive care-as-usual from their general practitioner and other care providers. Discussion We expect that the case management program, which includes better structured care based on scientific evidence and adjusted to the patients' needs and priorities, will improve the quality of care coordination from both the patients' and caregivers' perspective and will result in less consumption of health care services. Trial registration Netherlands Trial Register (NTR): NTR1847
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Affiliation(s)
- Nathalie Versnel
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
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Pieters A, Akkermans H, Franx A. E pluribus unum: using group model building with many interdependent organizations to create integrated health-care networks. Adv Health Care Manag 2011; 10:321-344. [PMID: 21887953 DOI: 10.1108/s1474-8231(2011)0000010025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This chapter reports on an action research case study of integrated obstetric care in the Netherlands. Efficient and patient-friendly patient flows through integrated care networks are of major societal importance. How to design and develop such interorganizational patient flows is still a nascent research area, especially when dealing with a large number (n>3) of stakeholders. We have shown that a modification of an existing method to support interorganizational collaboration by system dynamics-based group model building (GMB) (the Renga method, Akkermans, 2001) may be effective in achieving such collaboration.
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Fortin M, Hudon C, Gallagher F, Ntetu AL, Maltais D, Soubhi H. Nurses joining family doctors in primary care practices: perceptions of patients with multimorbidity. BMC FAMILY PRACTICE 2010; 11:84. [PMID: 21050443 PMCID: PMC2987912 DOI: 10.1186/1471-2296-11-84] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 11/04/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Among the strategies used to reform primary care, the participation of nurses in primary care practices appears to offer a promising avenue to better meet the needs of vulnerable patients. The present study explores the perceptions and expectations of patients with multimorbidity regarding nurses' presence in primary care practices. METHODS 18 primary (health) care patients with multimorbidity participated in semi-directed interviews, in order to explore their perceptions and expectations in regard to the involvement of nurses in primary care practices. Interviews were audio-recorded and transcribed. After reviewing the transcripts, the principal investigator and research assistants performed thematic analysis independently and reached consensus on the retained themes. RESULTS Patients with multimorbidity were open to the participation of nurses in primary care practices. They expected greater accessibility, for both themselves and for new patients. However, the issue of shared roles between nurses and doctors was a source of concern. Many patients held the traditional view of the nurse's role as an assistant to the doctor in his or her various duties. In general, participants said they were confident about nurses' competency but expressed concern about nurses performing certain acts that their doctor used to, notwithstanding a close collaboration between the two professionals. CONCLUSION Patients with multimorbidity are open to the involvement of nurses in primary care practices. However, they expect this participation to be established using clear definitions of professional roles and fields of practice.
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Affiliation(s)
- Martin Fortin
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Frances Gallagher
- School of Nursing Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Antoine L Ntetu
- Department of Humanities, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Danielle Maltais
- Department of Humanities, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Hassan Soubhi
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada
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Shin SM, Kim MJ, Kim ES, Lee HW, Park CG, Kim HK. Medical Aid service overuse assessed by case managers in Korea. J Adv Nurs 2010; 66:2257-65. [DOI: 10.1111/j.1365-2648.2010.05364.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care. OBJECTIVE To review CCM with an ethical lens. METHODS We reviewed the published empirical and non-empirical articles of CCM to analyse the ethical underpinnings of this model. RESULTS AND CONCLUSIONS We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients' health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor-patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes.
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Affiliation(s)
- Liviu Oprea
- Discipline of Public Health, The University of Adelaide, Adelaide, Australia.
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Soubhi H, Bayliss EA, Fortin M, Hudon C, van den Akker M, Thivierge R, Posel N, Fleiszer D. Learning and caring in communities of practice: using relationships and collective learning to improve primary care for patients with multimorbidity. Ann Fam Med 2010; 8:170-7. [PMID: 20212304 PMCID: PMC2834724 DOI: 10.1370/afm.1056] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We introduce a primary care practice model for caring for patients with multimorbidity. Primary care for these patients requires flexibility and ongoing coordination, and it often must be tailored to individual circumstances. Such complex and flexible care could be accomplished within communities of practice, whose participants are willing to learn from their shared practice, further each other's goals, share their stories of success and failure, and promote the continued evolution of collective learning. Primary care in these communities would be conceived as a complex adaptive process in which the participants use an iterative approach to care improvement that integrates what they learn and do collectively over time. Clinicians in these communities would define common goals, cocreate care plans, and engage in reflective case-based learning. As community members manage their knowledge, gain insights, and develop new care strategies, they can improve care for patients with multiple conditions. Using a mix of methods, future research should explore the conditions that are necessary for collective learning within communities of clinicians who care for patients with multimorbidity and who develop new knowledge in practice. By understanding these conditions, we can foster the development of collective learning and improve primary care for these patients.
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Affiliation(s)
- Hassan Soubhi
- Family Medicine Unit, University of Sherbrooke, Chicoutimi, Quebec, Canada.
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Jones R, Jordan S. The implementation of crisis resolution home treatment teams in wales: results of the national survey 2007-2008. Open Nurs J 2010; 4:9-19. [PMID: 20502646 PMCID: PMC2874216 DOI: 10.2174/1874434601004010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 11/22/2022] Open
Abstract
Background: In mental health nursing, Crisis Resolution and Home Treatment (CRHT) services are key components of the shift from in-patient to community care. CRHT has been developed mainly in urban settings, and deployment in more rural areas has not been examined. Aim: We aimed to evaluate CRHT services’ progress towards policy targets. Participants and Setting: All 18 CRHT teams in Wales were surveyed. Methods: A service profile questionnaire was distributed to team leaders. Findings: Fourteen of 18 teams responded in full. All but one were led by nurses, who formed the main professional group. All teams reported providing an alternative to hospital admission and assisting early discharge. With one exception, teams were ‘gatekeeping’ hospital beds. There was some divergence in clients seen, perceived impact of the service, operational hours, distances travelled, team structure, input of consultant psychiatrists and caseloads. We found some differences between the 8 urban teams and the 6 teams serving rural or mixed areas: rural teams travelled more, had fewer inpatient beds, and less medical input (0.067 compared to 0.688 whole time equivalents).. Most respondents felt that resource constraints were limiting further developments. Implications: Teams met standards for CHRT services in Wales; however, these are less onerous than those in England, particularly in relation to operational hours and staffing complement. As services develop, it will be important to ensure that rural and mixed areas receive the same level of input as urban areas.
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Affiliation(s)
- Richard Jones
- Hywel Dda NHS Trust, Hafan Derwen, Parc Dewi Sant, Carmarthen, SA31 3BB, UK
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Rothman RL, Yin HS, Mulvaney S, Co JPT, Homer C, Lannon C. Health literacy and quality: focus on chronic illness care and patient safety. Pediatrics 2009; 124 Suppl 3:S315-26. [PMID: 19861486 DOI: 10.1542/peds.2009-1163h] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorable factor for improving quality of care. Studies of adults have documented that lower health literacy is independently associated with poorer understanding of prescriptions and other medical information and worse chronic disease knowledge, self-management behaviors, and clinical outcomes. There is also growing evidence to suggest that health literacy is important in pediatric safety and chronic illness care. Adult studies have suggested that addressing literacy can lead to improved patient knowledge, behaviors, and outcomes. Early studies in the field of pediatrics have shown similar promise. There are significant opportunities to evaluate and demonstrate the importance of health literacy in improving pediatric quality of care. Efforts to address health literacy should be made to apply the 6 Institute of Medicine aims for quality-care that is safe, effective, patient centered, timely, efficient, and equitable. Efforts should also be made to consider the distinct nature of pediatric care and address the "4 D's" unique to child health: the developmental change of children over time; dependency on parents or adults; differential epidemiology of child health; and the different demographic patterns of children and their families.
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Affiliation(s)
- Russell L Rothman
- Vanderbilt University Medical Center, Vanderbilt Center for Health Services Research, Internal Medicine and Pediatrics, Suite 6000 Medical Center East, Nashville, TN 37232-8300, USA.
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Skala N. The potential impact of the World Trade Organization's general agreement on trade in services on health system reform and regulation in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2009; 39:363-87. [PMID: 19492630 DOI: 10.2190/hs.39.2.h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The collapse of the World Trade Organization's (WTO) Doha Round of talks without achieving new health services liberalization presents an important opportunity to evaluate the wisdom of granting further concessions to international investors in the health sector. The continuing deterioration of the U.S. health system and the primacy of reform as an issue in the 2008 presidential campaign make clear the need for a full range of policy options for addressing the national health crisis. Yet few commentators or policymakers realize that existing WTO health care commitments may already significantly constrain domestic policy options. This article illustrates these constraints through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues. The author concludes with some recommendations to the U.S. Trade Representative to suspend existing liberalization commitments in the health sector and to interpret current and future international trade treaties in a manner consistent with civilized notions of health care as a universal human right.
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Affiliation(s)
- Nicholas Skala
- Northwestern University School of Law, Chicago, IL 60611, USA.
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Multimorbidity and risk among patients with established cardiovascular disease: a cohort study. Br J Gen Pract 2008; 58:488-94. [PMID: 18611315 DOI: 10.3399/bjgp08x319459] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Most patients managed in primary care have more than one condition. Multimorbidity presents challenges for the patient and the clinician, not only in terms of the process of care, but also in terms of management and risk assessment. AIM To examine the effect of the presence of chronic kidney disease and diabetes on mortality and morbidity among patients with established cardiovascular disease. DESIGN OF STUDY Retrospective cohort study. SETTING Random selection of 35 general practices in the west of Ireland. METHOD A practice-based sample of 1609 patients with established cardiovascular disease was generated in 2000-2001 and followed for 5 years. The primary endpoint was death from any cause and the secondary endpoint was a cardiovascular composite endpoint that included death from a cardiovascular cause or any of the following cardiovascular events: myocardial infarction, heart failure, peripheral vascular disease, or stroke. RESULTS Risk of death from any cause was significantly increased in patients with increased multimorbidity (P<0.001), as was the risk of the cardiovascular composite endpoint (P<0.001). Patients with cardiovascular disease and diabetes had a similar survival pattern to those with cardiovascular disease and chronic kidney disease, but experienced more cardiovascular events. CONCLUSION Level of multimorbidity is an independent predictor of prognosis among patients with established cardiovascular disease. In such patients, the presence of chronic kidney disease carries a similar mortality risk to diabetes. Multimorbidity may be a useful factor in prioritising management of patients in the community with significant cardiovascular risk.
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Affiliation(s)
- R Birtwhistle
- Department of Family Medicine, Queen's University, Kingston, Ontario K7L5E9, Canada.
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Holmes AM, Ackermann RD, Zillich AJ, Katz BP, Downs SM, Inui TS. The Net Fiscal Impact Of A Chronic Disease Management Program: Indiana Medicaid. Health Aff (Millwood) 2008; 27:855-64. [DOI: 10.1377/hlthaff.27.3.855] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | - Thomas S. Inui
- Indiana University Purdue University Indianapolis (IUPUI)
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La gestión de casos y de enfermedades, y la mejora de la coordinación de la atención sanitaria en España. Informe SESPAS 2008. GACETA SANITARIA 2008; 22 Suppl 1:163-8. [DOI: 10.1016/s0213-9111(08)76088-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The NHS Plan signalled the creation of GPs with special interests (GPwSIs) in the UK. The role of a GPwSI involves the acquisition of knowledge and skills that enable GPs to dedicate a portion of their time to performing the role of consultants to their colleagues within the ambit of general practice, and with respect to specific health problems encountered. The objectives behind the introduction of GPwSIs are to improve the patient's access to specialist care, to cut waiting-list times, and to save on referral costs, (and as a consequence to increase the prestige of the GPs involved). However, the reality may not meet these expectations. Before accepting the proposition for universal implementation of GPwSIs empirical evidence is required to demonstrate that overall health is improved (of patients as well as the population); patients, especially patients of doctors working alone or in small groups (specifically in rural areas) are not disadvantaged; referral is improved and made more appropriate to the requirements of patients and their health problems; real prestige is generated, not only among GPs and students, but also among patients; biological views typical of the specialist are not promoted; and a brake is not applied to other alternatives in, or the reorganisation of, primary care.
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Berra K, Ma J, Klieman L, Hyde S, Monti V, Guardado A, Rivera S, Stafford RS. Implementing cardiac risk-factor case management: lessons learned in a county health system. Crit Pathw Cardiol 2007; 6:173-179. [PMID: 18091408 DOI: 10.1097/hpc.0b013e31815b5609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
METHODS Case-management (CM) can positively influence chronic disease care by facilitating guideline-concordant interventions that improve outcomes through intensive, individualized, longitudinal care. Implementation of CM, however, is difficult. We have identified lessons learned from a cardiovascular risk reduction CM program that may aid future CM implementation. INTRODUCTION Heart to Heart is both a clinical trial and program dissemination project implementing CM for persons at elevated risk of coronary heart disease (CHD) events in a multiethnic, low-income population in a county health system. Patients were randomized to CM plus usual primary care (N = 212) or primary care alone (N = 207). CM patients received face-to-face nurse and dietitian visits (mean of 14 hours) over 17 months. Visits emphasized behavior change, risk-factor monitoring, and guideline-based pharmacotherapy. A total of 341 patients (81%) were available for follow-up. This CM model is currently transitioning to a County-run program. RESULTS Findings demonstrated statistically significant reductions in mean Framingham Risk for CM versus usual primary care (1.56% absolute decrease in 10-year CHD risk, P = 0.007). Favorable changes were noted across most major CHD risk factors. Lessons learned are the need for the following: (1) Strategies for implementing CM in low-income, ethnically-diverse populations, (2) Methods for developing clinically more effective CM, and (3) Approaches to increase the efficiency of cardiovascular CM. CONCLUSIONS CM for cardiac risk factors faces notable implementation barriers, particularly in County health systems. Specific implementation solutions recommended may help confront these barriers and improve diffusion of this evidence-based and patient centered model of care.
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Affiliation(s)
- Kathy Berra
- Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305-5705, USA.
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Edworthy SM, Baptie B, Galvin D, Brant RF, Churchill-Smith T, Manyari D, Belenkie I. Effects of an enhanced secondary prevention program for patients with heart disease: a prospective randomized trial. Can J Cardiol 2007; 23:1066-72. [PMID: 17985009 PMCID: PMC2651931 DOI: 10.1016/s0828-282x(07)70875-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 08/23/2007] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Secondary prevention medications in cardiac patients improve outcomes. However, prescription rates for these drugs and long-term adherence are suboptimal. OBJECTIVE To determine whether an enhanced secondary prevention program improves outcomes. METHODS Hospitalized patients with indications for secondary prevention medications were randomly assigned to either usual care or an intervention arm, in which an intensive program was used to optimize prescription rates and long-term adherence. Follow-up was 19 months. RESULTS A total of 2643 patients were randomly assigned in the study; 1342 patients were assigned to usual care and 1301 patients were assigned to the intervention arm. Prescription rates were near optimal except for lipid-lowering medications. Rehospitalization rates per 100 patients were 136.2 and 132.6 over 19 months in the usual care and intervention groups, respectively (P=0.59). Total days in hospital per patient were similar (10.9 days in the usual care group versus 10.2 days in the intervention group; P not significant). Crude mortality was 6.2% and 5.5% in the usual care and intervention groups, respectively, with no significant difference (P=0.15) in overall survival. Post hoc analysis suggested that after the study team became experienced, days in hospital per patient were reduced by the program (11.1+/-0.91 and 8.9+/-0.61 in the usual care and intervention groups, respectively; P<0.05). CONCLUSIONS The intervention program failed to improve outcomes in the present study. One explanation for these results is the near optimal physician compliance with guidelines in both groups. It is also possible that a substantial learning curve for the staff was involved, as suggested by the reduction in total days in hospital in the intervention patients during the second part of the study.
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Affiliation(s)
- Steven M Edworthy
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Bonnie Baptie
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Donna Galvin
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Rollin F Brant
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Terry Churchill-Smith
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Dante Manyari
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
| | - Israel Belenkie
- Departments of Cardiac Sciences and Medicine and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta
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Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J, McDaniel RR. Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes. Implement Sci 2007; 2:28. [PMID: 17725834 PMCID: PMC2018702 DOI: 10.1186/1748-5908-2-28] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 08/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes. METHODS We conducted a systematic review of the literature on organizational interventions to improve care of Type II diabetes. For each study we recorded measured process and clinical outcomes of diabetic patients. Two independent reviewers gave each study a score that reflected whether organizational interventions reflected one or more characteristics of a complex adaptive system. The effectiveness of the intervention was assessed by standardizing the scoring of the results of each study as 0 (no effect), 0.5 (mixed effect), or 1.0 (effective). RESULTS Out of 157 potentially eligible studies, 32 met our eligibility criteria. Most studies were felt to utilize at least one CAS characteristic in their intervention designs, and ninety-one percent were scored as either "mixed effect" or "effective." The number of CAS characteristics present in each intervention was associated with effectiveness (p = 0.002). Two individual CAS characteristics were associated with effectiveness: interconnections between participants and co-evolution. CONCLUSION The significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes.
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Affiliation(s)
- Luci K Leykum
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - Jacqueline Pugh
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - Valerie Lawrence
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - Michael Parchman
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - Polly H Noël
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - John Cornell
- South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA
| | - Reuben R McDaniel
- McComb's School of Business, University of Texas at Austin, Austin TX, USA
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Stafford RS, Berra K. Critical Factors in Case Management: Practical Lessons from a Cardiac Case Management Program. ACTA ACUST UNITED AC 2007; 10:197-207. [PMID: 17718658 DOI: 10.1089/dis.2007.103624] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Case management (CM) is an important strategy for chronic disease care. By utilizing non-physician providers for conditions requiring ongoing care and follow-up, CM can facilitate guideline-concordant care, patient empowerment, and improvement in quality of life. We identify a series of critical factors required for successful CM implementation. Heart to Heart is a clinical trial evaluating CM for coronary heart disease (CHD) risk reduction in a multiethnic, low-income population. Patients at elevated cardiac risk were randomized to CM plus primary care (212 patients) or to primary care alone (207). Over a mean follow-up of 17 months, patients received face-to-face nurse and dietitian visits. Mean contact time was 14 hours provided at an estimated cost of $1250 per patient for the 341 (81%) patients completing follow-up. Visits emphasized behavior change, risk-factor monitoring, self-management skills, and guideline-based pharmacotherapy. A statistically significant reduction in mean Framingham risk probability occurred in CM plus primary care relative to primary care alone (1.6% decrease in 10-year CHD risk, p = 0.007). Favorable changes were noted across individual risk factors. Our findings suggest that successful CM implementation relies on choosing appropriate case managers and investing in training, integrating CM into existing care systems, delineating the scope and appropriate levels of clinical decision making, using information systems, and monitoring outcomes and costs. While our population, setting, and intervention model are unique, these insights are broadly relevant. If implemented with attention to critical factors, CM has great potential to improve the process and outcomes of chronic disease care.
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Affiliation(s)
- Randall S Stafford
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA.
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Eijkelberg IM, Spreeuwenberg C, Mur-Veeman IM, Wolffenbuttel BH. From shared care to disease management: key-influencing factors. Int J Integr Care 2007; 1:e17. [PMID: 16896415 PMCID: PMC1484400 DOI: 10.5334/ijic.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.
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Affiliation(s)
- I M Eijkelberg
- Faculty of Health Sciences, Department of Health Organisation, Policy and Economics, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Afifi AA, Morisky DE, Kominski GF, Kotlerman JB. Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid Program. Prev Med 2007; 44:547-53. [PMID: 17350086 DOI: 10.1016/j.ypmed.2007.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 02/01/2007] [Accepted: 02/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the impact of disease management on utilization of selected health care services. METHOD Prospective observational population-based study comparing Florida Medicaid patients who elected to participate in disease management (DM, N=15,275) with a usual-care (UC, N=32,034) group who elected not to participate in the program. Patients had at least one of four chronic diseases (diabetes, asthma, congestive heart failure, and hypertension) and all received standard health care. DM participants received supplementary telephone health counseling by a managed care specialist. The data for this paper were collected between October 2001 and October 2004. RESULTS Annual rates of inpatient hospital stays, inpatient days, emergency room (ER) visits, and outpatient (OP) visits, during and post intervention, were used as outcomes. Age, race, gender, comorbidities, severity indicators, geographic location and pre-intervention utilization were used as covariates. Compared to UC patients, DM patients had lower adjusted post intervention annualized rates of hospitalizations ranging from 0.07 to 0.38 stays, lower rates of hospital days ranging from 0.40 to 2.54 days, and lower rates of ER visits ranging from 0.10 to 0.91 visits per DM enrollee in all four chronic conditions. Most results were statistically significant at the 5% level, except for hypertension patients, where they were suggestive, though not significant. CONCLUSION Disease management is effective in reducing potentially avoidable inpatient hospital stays and ER visits among patients with chronic illness.
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Rich EC, Maio A. Late to the feast: primary care and US health policy. Am J Med 2007; 120:553-9. [PMID: 17524761 DOI: 10.1016/j.amjmed.2007.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 01/05/2007] [Accepted: 03/01/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Eugene C Rich
- Department of Medicine, Creighton University School of Medicine, Omaha, Neb 68131, USA.
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Abstract
Disease management is being promulgated by many policy makers, legislators, and a burgeoning new disease management industry as the next major hope, together with information technology and consumer-directed health care, to bring cost containment to runaway costs of health care. Many expect quality improvement as well. The concept is being aggressively marketed to employers, health plans, and government in the wake of managed care's failure to contain costs. There is widespread confusion, however, about what disease management is and what impact it will have on patients, physicians, and the health care system itself. In this article I give a current snapshot of disease management by briefly addressing (1) its rationale and growth, (2) its track record concerning costs and quality of care, and (3) its impacts on primary care.
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Affiliation(s)
- John P Geyman
- Department of Family Medicine, University of Washington, Seattle, Wash, USA.
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Charlson M, Charlson RE, Briggs W, Hollenberg J. Can disease management target patients most likely to generate high costs? The impact of comorbidity. J Gen Intern Med 2007; 22:464-9. [PMID: 17372794 PMCID: PMC1829434 DOI: 10.1007/s11606-007-0130-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Disease management programs are increasingly used to manage costs of patients with chronic disease. OBJECTIVE We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs. DESIGN Retrospective analysis of prospectively obtained data. SETTING A general medicine practice with both faculty and residents at an urban academic medical center. PARTICIPANTS Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year. MAIN OUTCOMES Annual cost of diseases targeted by disease management. MEASUREMENTS Patients' clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs. RESULTS Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs. CONCLUSIONS Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.
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Affiliation(s)
- Mary Charlson
- Division of General Internal Medicine, Center for Complementary and Integrative Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Galvin RS, Delbanco S. Between A Rock And A Hard Place: Understanding The Employer Mind-Set. Health Aff (Millwood) 2006; 25:1548-55. [PMID: 17102179 DOI: 10.1377/hlthaff.25.6.1548] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Large and mid-size employers are "between a rock and hard place" when it comes to health benefits: They are both unable to manage their health care costs effectively or simply get out of offering these benefits entirely. Although there is considerable diversity in how employers approach health care, several goals underlie most of their decisions. It is unlikely that the current round of employer-based health initiatives will succeed at managing rising costs. As a result, employers are likely to become more interested than at any time in the past decade in exiting their roles as providers of health benefits.
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Affiliation(s)
- Robert S Galvin
- Global Health Care, General Electric Company in Fairfield, Connecticut, USA.
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Krumholz HM, Currie PM, Riegel B, Phillips CO, Peterson ED, Smith R, Yancy CW, Faxon DP. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation 2006; 114:1432-45. [PMID: 16952985 DOI: 10.1161/circulationaha.106.177322] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness. METHODS The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework. RESULTS The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden. CONCLUSIONS This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.
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Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med 2006; 4:104-8. [PMID: 16569712 PMCID: PMC1467012 DOI: 10.1370/afm.516] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Many randomized controlled trials (RCTs) exclude patients who have multiple comorbidities. The aim of this study was to illustrate the prevalence of comorbidities among patients followed up in primary care who would have met the inclusion criteria of selected RCTs focusing on treatment of a particular condition. We used hypertension as an example of a particular chronic condition. METHODS We used an existing database of 980 patients (660 women) that was representative of a population consulting primary care family doctors and that contained information about all chronic conditions. We randomly selected 5 RCTs that focused on patients with hypertension. The inclusion and exclusion criteria used in each of the 5 RCTs were applied (1 study at a time) to the patients in our database. The patients from our data set who met the inclusion criteria of a given RCT were considered eligible for that RCT. RESULTS Of the patients from our data set who were eligible for each of the RCTs, 89% to 100% had multiple chronic conditions. The mean number of chronic conditions of patients eligible for each RCT ranged from 5.5 +/- 3.3 to 11.7 +/- 5.3. CONCLUSIONS Results from this study suggest that RCTs targeting a chronic medical condition such as hypertension could find that, in a sample taken from family practice, most eligible patients have comorbid conditions. Whether these patients are sampled or excluded should be reported. Research results intended to be applied in medical practice should take the complex reality of effective treatment of these patients into consideration.
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Affiliation(s)
- Martin Fortin
- Department of Family Medicine, Sherbrooke University, Sherbrooke, Québec, Canada.
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Cigolle CT, Langa KM, Kabeto MU, Blaum CS. Setting eligibility criteria for a care-coordination benefit. J Am Geriatr Soc 2006; 53:2051-9. [PMID: 16398887 DOI: 10.1111/j.1532-5415.2005.00496.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served. DESIGN Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older. SETTING Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey. PARTICIPANTS Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries). MEASUREMENTS Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency. RESULTS A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population. CONCLUSION Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.
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Affiliation(s)
- Christine T Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Ratner D, Louria D, Sheffet A, Fain R, Curran J, Saed N, Bhaskar S, Quereshi M, Cable G. Wealth from Health: an incentive program for disease and population management: a 12-year project. ACTA ACUST UNITED AC 2006; 6:184-204. [PMID: 16398037 DOI: 10.1097/00129234-200109000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.
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Affiliation(s)
- D Ratner
- Overlook Hospital, 99 Beauvoir Avenue, Summit, NJ 07901, USA
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Levine S, Reyes JY, Schwartz R, Schmidt D, Schwab T, Leung M. Disease Management of the Frail Elderly Population. ACTA ACUST UNITED AC 2006. [DOI: 10.2165/00115677-200614040-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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