Leveraging the trusted clinician: documenting disease management program enrollment.

The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.     

A cohort study of the impact of a national disease management program on HEDIS diabetes outcomes.

Diabetes disease management programs (DDMP) are proliferating, but their overall impact in improving quality of care using Health Employer Data and Information Set (HEDIS) quality metrics has not been well studied. Furthermore, DDMPs are usually ongoing, but the incremental benefits of continuing the program beyond the initial patient educational intervention have not been rigorously tested. This study evaluates the impact of length of DDMP participation on diabetes-related HEDIS 2002 quality indicators across 20 health plans. Results are stratified by duration of DDMP participation into three levels, "full participants" (6-12 months duration), "partial participants" (<6 months duration) and "non-participants" (0 months duration). The overall national compliance rate across all six combined HEDIS quality measures was 65.6% among full-participants (FP), 58.4% among partial-participants (PP) and 57.0% among non-participants (NP). This study demonstrates that participants in a comprehensive DDMP fair better than non-participants and that those with sustained participation (>6 months) benefit the most.     

The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.     

The impact of a high-risk disease management program on perinatal outcomes in a managed care organization

Improvements in technology have increased the chances of survival for the micropremature infant and the very low birth-weight infant but have significantly increased the financial burden of health care organizations. This economic burden has a significant impact on third-party payers and on society in general. Of the annual US 10.2 billion dollars spent on newborn care alone, 57% is disproportionately consumed by the 10% of infants who are born preterm.     

上海市医院门诊部服务质量与病人满意度的关系研究

[目的]了解影响病人满意度的服务质量属性。[方法]自行设计问卷,对上海市3所三级甲等医院和1所二级甲等医院的202位病人进行满意度调查,结果采用因子分析与多元线性回归分析。[结果]影响病人满意度的服务质量属性包括五大类:医生关心、医生专业能力、工作人员关心、环境与设施和等待时间。其中,医生专业能力是影响病人满意度的最大因素,其次分别为工作人员关心、医生关心、环境与设施,等待时间的影响较弱。[结论]根据服务质量属性重要程度的不同采取不同的管理措施。     

How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study

Background  

The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises.     

Impact of a diabetes disease management program on diabetes control and patient quality of life

The worldwide burden of diabetes is projected to be 5.4% of the adult population by the year 2025. Diabetes is associated with multiple medical complications that both decrease health-related quality of life (HR-QOL) and contribute to earlier mortality. There is growing evidence for the effectiveness of multidisciplinary disease management programs that incorporate self-management principles in improving patients' long-term outcomes. The aim of this project was to evaluate the effectiveness of this approach in improving: (1) glycemic control measured by HbA1c, and (2) HR-QOL measured by the Assessment of Quality of Life (AQOL), at enrollment and at 12-months follow-up. Between 2004 and 2008, a total of 967 patients were enrolled in the program; 545 (56%) of these patients had HbA1c data available at baseline and at 12 months. Mean HbA1c at enrollment was 8.6% (SD 1.9) versus 7.3% (SD 1.2) at 12 months (P<0.001). Overall, 68% of patients experienced improvements in HbA1c. At enrollment, patients reported "fair" HR-QOL, which was significantly lower than age-adjusted population norms who reported "good" HR-QOL. At 12 months, 251 (64%) patients had improved HR-QOL, 27 (7%) had no change, and 114 (29%) deteriorated. Mean utility scores improved by 0.11 (P<0.001), which is almost twice the minimum clinically important difference for the AQOL. This study confirms that a multidisciplinary disease management program for patients with poorly controlled type 2 diabetes can improve both glycemic control and HR-QOL.     

Quantitative and qualitative assessment of a case management program for cancer patients.

An oncology social work case management model of intervention is described quantitatively and qualitatively. Sixty-nine newly diagnosed breast cancer patients followed by telephone for one year required 374 hours of the social worker's time in providing reassurance, information, and referral to existing community resources. This process took less than one-half hour per patient per month. Case examples provide insight into the clinical aspects of the social worker's efforts. This telephone-based model was found to be highly effective and cost-efficient in addressing the rehabilitation needs of cancer patients. It also is a generic model that can be used with cancer patients with any disease site or phase of illness.     

Factors that enable and inhibit transition from a weight management program: a qualitative study

Failure of clients to initiate closure and move out of weight management programs after it is considered they should have reached the stage of maintenance in their health behavior change has implications for clients' self-management, provision of health promotion programs and their cost-effectiveness. This study aims to identify factors that enable and inhibit class attendees' transition from a weight management program. Six short-term attendees who had left the program after two terms and six long-term attendees who had attended four or more terms of the program volunteered to participate in in-depth interviews. Enabling factors were identified to be program knowledge and attainment of set goal weight, and inhibiting factors were the perceived need to come to classes, concern about keeping in control, recognition of the potential to lapse and being involved with a group. Recommendations are made for the program to include a component addressing relapse prevention training and to trial some form of follow-up support strategy. Additionally, further research is needed into transition from weight management programs.     

宫内营养不良与心血管病的危险性

肥胖、吸烟、缺乏运动等均是冠心病、高血压、糖尿病的危险因子。但近来随着一些心血管病流行现象的显现,“胎源假说”是其新危险因子的观点逐渐明朗化。在2 0世纪40～60年代,西方国家经历了心血管病的快速上升期,那时正值2 0世纪初在相对贫困时期出生的人群步入中老年,而此时经济繁荣带来的富营养膳食结构使心血管疾病的患病率节节攀高。随着人群(尤其孕妇)营养状况的改善,尽管2 0年来一些西方人群的生活方式变化不大,而心血管病的发病率却出现了显著下降。另一个明显的流行特征是:目前发展中国家的心血管病流行率随经济的发达而迅速升高并…     

An epidemiologic study of the relationship between hepatitis A and water supply characteristics and treatment.

Outbreaks of hepatitis A (HA) attributable to water contamination have been reported; however, the impact of water supply characteristics on the endemic rates of HA has not been quantified. This study did not detect any statistically significant associations between endemic HA rates and water supply characteristics. Because of the sample size, this finding suggests that the total variation of HA rates attributable to water supply characteristics is probably less than 8 per cent of the annual reported cases of HA in the United States.     

Evaluation of a medicaid asthma disease management program.

This study evaluates 1-year outcomes of an asthma disease management program implemented in an Oregon Medicaid population. A non-randomized pre-post study, a matched case-control study, and a "programmatic effects" analysis were conducted. Compared to matched controls, the treatment cohort had significantly fewer emergency room visits per thousand (7 vs. 28, P < 0.001) and higher office visits per thousand (57 vs. 7, P < 0.0001) but no significant difference in hospital admission rates. The programmatic effects model identified the participants' initial severity levels and the number of various communications they received as the most important variables in explaining the change in asthma severity from baseline to 12 months. These findings are supportive of the DM design, which is to reduce acute services by improving coordination of care between patients and their providers. Additionally, it appears that there is a close association between the number of patient contacts and their subsequent change in health status.