The Physician's Guide to Disease Management

This book is designed to provide the physician with a working knowledge 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. It 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)

Sumary and Prospectus

26

(3)

Chapter 2 -- Evidence-Based Medicine

29

(28)

Tony Felton

Defining EBM

29

(1)

Background of EBM

30

(1)

From Theory to Practice?

31

(6)

Physicians and EBM

37

(4)

How Will EBM Affect Key Constituents within Health Care?

41

(8)

The Role of Information Technology

49

(2)

Creating an Environment to Encourage EBM

51

(1)

New Ways of Working as a Consequence of EBM

52

(1)

Looking to the Future

53

(4)

Chapter 3 -- Outcome Validated Clinical Practice Guidelines: A Scientific Foundation for Disease Management

57

(26)

Scott Weingarten

Geneen Graber

Treatment and Diagnostic Overutilization: A Health Care Dilema

58

(1)

Past Attempts at Medical Cost Containment

58

(3)

The Concept of Disease Management

61

(1)

Physicians' Perspective on Disease Management

61

(1)

Clinical Practice Guidelines

62

(10)

Outcome Measurement

72

(4)

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

76

(7)

Chapter 4 -- The Role of Outcomes Management in Disease Management

83

(30)

Spencer Borden IV

Collection and Evaluation of Health Care Data

85

(12)

Analysis of Health Care Data

97

(5)

Production of Measures

102

(9)

Conclusion

111

(2)

Chapter 5 -- Information Systems for Disease Management

113

(34)

David J. Brailer

Jason Dandridge

Disease Management Information Strategy

115

(10)

Core Technologies

125

(14)

Development and Implementation

139

(5)

Discussion and Conclusions

144

(3)

Chapter 6 -- Disease Management: Making It Work A Study in Implementation Strategies and Results in an Integrated Delivery System

147

(20)

John J. Byrnes

John Lucas

Margaret J. Gunter

Lovelace Health Systems

148

(1)

Episodes of Care(TM)

148

(17)

Summary and Additional Lessons Learned

165

(2)

Chapter 7 -- Disease State Management in Managed Care Organizations

167

(32)

Robert E. McCormack

HEDIS

175

(1)

History of DM in MCOs

175

(1)

Current DM Programs in MCOs

176

(23)

Chapter 8 -- Disease Management in Pharmaceutical Companies

199

(32)

Harald Rinde

Changes in the Health Care Market

199

(3)

Changing Customers and Changing Needs in the Health Care Market

202

(7)

The Role of Disease Management

209

(1)

Development of the Disease Management Concept

210

(1)

Does Disease Management Produce Results?

211

(1)

Pharmaceutical Companies and Disease Management

212

(5)

Key Factors for Pharmaceutical Companies' Success in Disease Management

217

(3)

Benefits to Pharmaceutical Companies from Disease Management

220

(5)

Pharmaceutical Companies' Approach to Disease Management

225

(2)

Future of Disease Management in the Pharmaceutical Industry

227

(4)

Chapter 9 -- Disease Management Purchasers' Perspectives

231

(34)

Larry L. Hipp

Purchasers' Perspectives

232

(3)

Occupational and Environmental Medicine Perspective

235

(2)

Health Promotion and Demand Management

237

(3)

The Purchasing Community

240

(5)

The Accreditation and Measurement Community

245

(4)

Examples of Disease Management Programs in the Purchasing Community

249

(8)

Future Challenges and Opportunities

257

(8)

Chapter 10 -- Disease Management as Patient-Centered Care

265

(26)

David Levy

History of Health Care Management

266

(6)

Insufficiencies of the Old View

272

(4)

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

276

(5)

Putting It All Together

281

(7)

Conclusion

288

(3)

Epilogue Senator Bill Frist

291

(6)

Index

297

(14)

About the Editor

311

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The Physician's Guide to Disease Management

Summary

Table of Contents

Supplemental Materials