Disease Management Update
Volume III, No. 47
March 15, 2007
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Table of Contents
- Chronic DM Quality Improvement Efforts Yield Better Care Delivery, Not Outcomes
- Disease Management Q&A: Rating Physician Behavior
- HealthSounds Podcast: Maximizing the Results of Your Disease Management Programs Through Community-Based Resources
- Workplace DM Enrollment Rises When Patients Contacted by Trusted Clinicians
- Health Risk Assessments: First Line of Defense in Population Health Management
1. Chronic DM Quality Improvement Efforts Yield Better Care Delivery, Not Outcomes
A national series of interventions designed to improve the quality of care in health centers for three prevalent chronic conditions has improved processes of care for these conditions but did not improve intermediate clinical outcomes, according to the results of a study collaboratively supported by the Agency for Healthcare Research and Quality and Health Resources and Services Administration and complemented by a grant from the Commonwealth Fund.
Researchers analyzed interventions with 9,658 patients at 44 health centers nationwide, approximately half of which were in urban areas. The interventions were focused on diabetes, asthma and hypertension. The researchers used nationally validated quality measures that were collected from medical record reviews conducted over a one-year period before the intervention and the same period after the intervention, and judged them against external control centers for comparison.
They found a number of process improvements, including a 21 percent increase in foot examinations for patients with diabetes; a 14 percent increase in the use of anti-inflammatory medication for patients with asthma; a 16 percent increase in the level of screening for glycated hemoglobin in persons with diabetes mellitus; and, overall across the three conditions, a 6 percent improvement in processes of care related to screening and disease prevention and a 5 percent improvement in processes related to disease monitoring and treatment.
However, even though processes were improved, the researchers found no improvement in intermediate outcomes, such as control of glycated hemoglobin for people with diabetes; control of blood pressure to normal levels for patients with hypertension; or a reduction in urgent care, emergency department visits or hospitalization for people with asthma.
To learn more about the findings of this study, please visit:
2. Disease Management Q&A: Rating Physician Behavior
Each week, a healthcare professional responds to a reader's
query on an industry issue. This week's expert is Gregg O. Lehman, Ph.D., currently the president and CEO of Health Fitness Corporation. At the time of his contribution to this DM Q&A, he was president and CEO of Gordian Health Solutions.
Question: How effective are physician-specific report cards in getting physicians to follow clinical practice guidelines? Is there any other type of literature that would support the effectiveness as well?
Response: In terms of physician behavior and physician outcomes, Gordian's model is a little different. In our DM modules that include diabetes, heart disease, hypertension, asthma, gastroesophageal reflux disease, cholesterol, behavior modification, obesity, low back pain and migraines, we require our participants to have a minimum of two physician interactions during the year. That's where the physician signs off on the process that we're using with that particular patient.
Our model does not try to change physician behavior per se. We try to reinforce physician behavior through the interactive programs that we put together with our participants in the program. The physician validates that these programs support the treatment protocol for that patient.
A great resource that addresses this specifically is the Disease Management Association of America (DMAA). They've commissioned an easy-to-use DM literature finder that consolidates the best cases and outcomes literature for DM programs, including some of the physician pieces that you've referenced. The system is called DM LitFinder™, which you can access that from their Web site.
For more details on primary care's role in DM, please visit:
We want to hear from you! Submit your question for Disease Management Q&A to firstname.lastname@example.org.
3. HealthSounds Podcast: Maximizing the Results of Your Disease Management Programs Through Community-Based Resources
In this week's Disease Management podcast, Michelle Brooks, R.N., M.S.N., administrator of regional health plans for Pitt County Memorial Hospital, University Health Systems of Eastern Carolina, describes how her organization's case managers identify and work with patients with chronic diseases to coordinate healthcare services and community-based services. In addition, Judith Szilagyi-Neary, clinical care manager at Ovations, a United Healthcare Company, outlines two programs provided through Ovations — a transition coach program and the Personal Service Delivery Program, both of which strategize and maximize community-based resources.
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4. Workplace DM Enrollment Rises When Patients Contacted by Trusted Clinicians
Enrollment rates in workplace DM programs can be improved by involving a familiar and trusted clinician in the recruiting process, as opposed to relying solely on anonymous telephone callers, according to a study from CHD Meridian Healthcare published in Disease Management, the peer-reviewed journal of the DMAA.
The study involved nearly 2,000 Goodyear Tire & Rubber Co. employees, dependents and retirees who were identified and invited to participate in DM programs to better control their diabetes, hypertension and coronary artery disease. They were selected to participate based on data demonstrating dramatic opportunities to improve their health and medical condition statuses.
The group, approached through established, trusted primary care clinicians delivering care at the workplace, were contacted and enrolled at significantly higher rates than those approached through the traditional "cold-call" process. Enrollment particularly spiked (79 percent) when patients were approached to participate during a regularly scheduled visit with a familiar clinician at their worksite health center.
To see more of this study's results, please visit:
5. Health Risk Assessments: First Line of Defense in Population Health Management
A powerful component of a health population management strategy is the health risk assessment (HRA), which evaluates a population's health status and targets actionable programs to address identified risks. Whether implemented by employers or health plans, developing effective HRAs and mining the resulting data is a strategic means of harnessing healthcare costs and fostering consumer awareness of their own health state. In a recent online survey, the Healthcare Intelligence Network polled its online audience to gauge the presence and power of HRAs in the healthcare industry.
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