The Health Care Professional's Guide to

The Health Care Professional's Guide to Disease Management is an essential reference for physicians, nurses, pharmacists, allied health professionals, and public health practitioners working in the area of disease management. In today's health care market where pressure is on both providers and managed care organizations to deliver high quality care to defined populations efficiently, knowledge of disease management is crucial. The book includes discussions of evidence-based medicine, clinical practice guidelines, and outcomes management.

Contributors

ix

(2)

Foreword

xi

(4)

Philip Caper

Preface

xv

(2)

Acknowledgments

xvii

Chapter 1--Disease Management: An Overview

1

(28)

James B. Couch

Origins and Evolution

1

(2)

Definition

3

(1)

Health Care Value

4

(2)

What DM Is Not (or Should Not Be)

6

(1)

Why DM Is So Important Now

7

(1)

The DM Process

8

(9)

Stakeholder Needs from Disease Management

17

(2)

Role of DM in the Broader Health Care Industry: Health Care Value Purchasing

19

(1)

Total Health Management

20

(2)

Alliance Management To Complete the Puzzle

22

(1)

A Case Study in Alliance Management

23

(1)

A Possible Future Course for Disease Management

24

(2)

Summary and Prospectus

26

(3)

Chapter 2--Disease Management: A Public Health Perspective

29

(24)

Paul K. Halverson

Glen P. Mays

Disease Management Concepts and Methods

29

(2)

Public Health Practice and Its Relevance to Disease Management

31

(9)

Similarities and Differences Between Disease Management and Public Health Practice

40

(6)

Remaining Issues and Next Steps

46

(4)

Conclusion

50

(3)

Chapter 3--Evidence-Based Medicine

53

(28)

Tony Felton

Defining EBM

53

(1)

Background of EBM

54

(1)

From Theory to Practice?

55

(6)

Physicians and EBM

61

(4)

How Will EBM Affect Key Constituents within Health Care?

65

(8)

The Role of Information Technology

73

(2)

Creating an Environment To Encourage EBM

75

(1)

New Ways of Working as a Consequence of EBM

76

(1)

Looking to the Future

77

(4)

Chapter 4--Outcome-Validated Clinical Practice Guidelines: A Scientific Foundation for Disease Management

81

(26)

Scott Weingarten

Geneen Graber

Treatment and Diagnostic Overutiliztion: A Health Care Dilemma

82

(1)

Past Attempts at Medical Cost Containment

82

(3)

The Concept of Disease Management

85

(1)

Physicians' Perspective on Disease Management

85

(1)

Clinical Practice Guidelines

86

(10)

Outcome Measurement

96

(4)

Recent Disease Management Programs Using an Evidence-Based Approach to Guidelines

100

(7)

Chapter 5--The Role of Outcomes Management in Disease Management

107

(30)

Spencer Borden IV

Collection and Evaluation of Health Care Data

109

(12)

Analysis of Health Care Data

121

(5)

Production of Measures

126

(9)

Conclusion

135

(2)

Chapter 6--Information System for Disease Management

137

(34)

David J. Brailer

Jason Dandridge

Disease Management Information Strategy

139

(10)

Core Technologies

149

(14)

Development and Implementation

163

(5)

Discussion and Conclusions

168

(3)

Chapter 7--Disease Management: Making It Work--A Study in Implementation Strategies and Results in an Integrated Delivery System

171

(20)

John J. Byrnes

John Lucas

Margaret J. Gunter

Lovelace Health Systems

172

(1)

EPISODES OF CARE (TM)

172

(17)

Summary and Additional Lessons Learned

189

(2)

Chapter 8--Disease State Management in Managed Care Organizations

191

(32)

Robert E. McCormack

HEDIS

199

(1)

History of DM in MCOs

199

(1)

Current DM Programs in MCOs

200

(23)

Chapter 9--Disease Management in Pharmaceutical Companies

223

(32)

Harald Rinde

Changes in the Health Care Market

223

(3)

Changing Customers and Changing Needs in the Health Care Market

226

(7)

The Role of Disease Management

233

(1)

Development of the Disease Management Concept

234

(1)

Does Disease Management Produce Results?

235

(1)

Pharmaceutical Companies and Disease Management

236

(5)

Key Factors for Pharmaceutical Companies' Success in Disease Management

241

(3)

Benefits to Pharmaceutical Companies from Disease Management

244

(5)

Pharmaceutical Companies' Approach to Disease Management

249

(2)

Future of Disease Management in the Pharmaceutical Industry

251

(4)

Chapter 10--Disease Management Purchasers' Perspectives

255

(34)

Larry L. Hipp

Purchasers Perspectives

256

(3)

Occupational and Environmental Medicine Perspective

259

(2)

Health Promotion and Demand Management

261

(3)

The Purchasing Community

264

(5)

The Accreditation and Measurement Community

269

(4)

Examples of Disease Management Programs in the Purchasing Community

273

(8)

Future Challenges and Opportunities

281

(8)

Chapter 11--Total Health Management: The Nursing Perspective

289

(10)

Carol Geary

Total Health Management--Philosophy and Operation

289

(7)

Conclusion

296

(3)

Chapter 12--Disease Management as Patient-Centered Care

299

(26)

David Levy

History of Health Care Management

300

(6)

Insufficiencies of the Old View

306

(4)

Patient-Centered Care as the New Paradigm of Health Care Management

310

(5)

Putting It All Together

315

(7)

Conclusion

322

(3)

Epilogue

325

(6)

Senator Bill Frist

Index

331

(14)

About the Editor

345

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The Health Care Professional's Guide to Disease Management: Patient-Centered Care for the 21st Century

Summary

Table of Contents

Supplemental Materials