Jaan Sidorov

Obesity Disease Management Opportunities and Barriers

Disease management, a system of coordinated health care interventions and communications for chronically ill populations, relies on patient education and case management to engage individuals in the management of their condition. Disease management also aims to enhance the quality of interactions between doctors and patients and advance evidence‐based medicine. Because these programs’ interventions frequently include helping individuals who suffer comorbidities associated with obesity to reduce their BMI, adaptation of disease management to populations with obesity seems a viable option. A major barrier for implementing disease management for obesity, however, is the lack of proven return on investment, which limits health plan and disease management organization interest. Purchaser demand may overcome this reluctance. Further research is needed to objectively test whether disease management interventions would be clinically effective for obese populations, produce positive financial outcomes for insurers, and enhance workplace productivity.

Use of the Short Form 36 in a Primary Care Based Disease Management Program for Patients with Congestive Heart Failure

While disease management has been described as an important strategy for the care of patients with congestive heart failure (CHF) in the managed care setting, little is known about the impact of this approach on overall health-related quality of life. In this study the Short Form 36 (SF-36) was administered to all patients entering CHF disease management at the time of program entry and at 1 year following entry. Scores on the eight subscales and the two composite scales were calculated and compared before and after. Patients were enrolled from a mixed-model health maintenance organization (HMO) with 34,740 Medicare + Choice enrollees residing in 38 counties in central and northeastern Pennsylvania. Two hundred sixty-eight continuously enrolled patients in an HMO-sponsored CHF disease state management program with completed baseline and follow-up SF-36 surveys were sampled. All patients entered into disease management received primary care based, nurse-directed education about CHF self-management including instruction on etiology of CHF, the importance of medication compliance, home care services if indicated, monitoring weight gain, increased understanding of the warning signs of worsening CHF, and coaching on strategies to contact a physician in a timely manner when CHF worsens. Nurses also facilitated for CHF guidelines among primary care physicians, including the need to obtain a baseline assessment of cardiac function, prescribe angiotensin I-converting enzyme (ACE) inhibitors and beta blockers when appropriate, and initiated appropriate specialist referral. Compared with enrollees who did not complete a pair of SF-36 surveys, the 268 respondents were younger and had a significantly higher rate of cardiac imaging as well as use of ACE inhibitors and beta blocker medications. Analysis of the SF-36 data revealed that three of the eight (Role Physical, General Health Perceptions, and Role Emotional) subscales increased in a statistically significant manner, as did the Mental Health Composite Score. No statistically significant declines in SF-36 scores were observed. Despite limitations to our study, we found disease management for patients with CHF can be associated with significant improvements in quality of life as measured by the SF-36. Compared with nonrespondents, respondents had a higher prevalence of cardiac imaging, ACE inhibitor use, and beta blocker medication use. Our findings are also limited by a lack of a control group with the possibility that the improvements we observed were unrelated to the disease management intervention. However, our findings and success with the use of this tool indicate the SF-36 can be an important part of the ongoing assessment of patients in a disease management program for CHF.

An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes

Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs.Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-sponsored case management and disease management programs for actively enrolled participants were compared during the fiscal year January 1, 1998 to November 31, 2000.Interventions: The disease management programs addressed asthma, diabetes mellitus and congestive heart failure (CHF). These programs were based on a network of primary care-based nurse educators and case managers promoting clinical guidelines, appropriate use of the insurance benefit, community-based resources, and communication among all healthcare providers.Setting and participants: This initiative was based in 55 primary care sites serving 295 000 insureds across northeastern and central Pennsylvania, USA.Results: 396 patients with asthma had mean baseline PMPM charges of

What is the Return on Investment Associated with Diabetes Disease Management? A Report from One Managed Care Organization in Pennsylvania, USA

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Does Diabetes Disease Management Save Money and Improve Outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization–sponsored disease management program among patients fulfilling health employer data and information set criteria

US276 PMPM after entry. In those with diabetes mellitus, 3556 patients had a mean baseline PMPM charge of

How are internal medicine residency journal clubs organized, and what makes them successful ?

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Disease management for diabetes mellitus: impact on hemoglobin A1c.

US346. The mean baseline PMPM charge decreased from

Principles for Assessing Disease Management Outcomes

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Measuring outcomes of type 2 diabetes disease management program in an HMO setting.

US1541 for 1795 patients with CHF. For 3346 patients undergoing case management, the mean baseline PMPM charge was

Streptokinase vs Heparin for Deep Venous Thrombosis: Can Lytic Therapy Be Justified?

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