One of the keys to optimums in aging
is the recognition that chroinic disease is common in the aging population and many of those cannot be cured but they can
be managed in a way so as to provide a high quality of life. Disease Management programs are an important factor in doing
that.
In Disease Management: A Systems
Approach to Improving Patient Outcomes (1997), Todd and Nash define disease management as:
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“…a comprehensive, integrated approach to care
and reimbursement based on a disease’s natural course. The goal of disease management is to address the illness or condition
with maximum effectiveness and efficiency regardless of treatment setting(s) or typical reimbursement patterns. This approach
emphasizes management of a disease in a manner that focuses both clinical and nonclinical interventions when and where they
are most likely to have the greatest positive impact. Ideally, disease management prevents exacerbation of a disease and the
use of expensive resources, making prevention and proactive case management two important areas of emphasis in most disease
management programs.” (P. 4)
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Disease management is establishing
a solid track record for improving cost-effectiveness for such chronic conditions as Diabetes, CHD and AIDs. Patrick Vega
(1999) has pointed out that while defined in different ways, all definitions of disease management have these features in
common:
- A set of interventions focused on a costly, chronic condition, disease or diagnosis (e.g., CHD).
- A coordinated clinical approach across multi-disciplinary treatment teams and modalities.
- Employment of evidence-based, standardized clinical practices that have been proven to be highly effective.
- Education that focuses on both patients and providers of care with specific targeted outcomes.
- An approach to care management that emphasizes both clinical efficacy and cost effectiveness.
- A method for systematically collecting outcomes data that is clinically and financially evaluative.
The characteristics of chronic disease have led to something
of a revolution in healthcare. The methods fit under the umbrella of Disease Management (DM). DM represents quite a departure
from the traditional medical model. It is one of the most psychology friendly developments in the last 50 years. DM uses the
biopsychosocial model of health and illness. Former American Psychological Association president Nicholas Cummings (Cummings
et. al., 2005) has been a leader in introducing psychological approaches to DM. In his report of the Fifth Reno Conference
on the Integration of Behavioral Health and Primary Care points out that although definitions vary all DM programs emphasize
prevention of exacerbations and complications, evidence-based guidelines and patient empowerment, collaborative practice methods
and patient self-management education. Among the most common elements in such programs are:
· Medical information about the illness
· Increasing motivation (e.g. MI) for
healthy behavior
· Decisional support regarding treatment
options
· Training in illness management skills
· Self-monitoring of risk behaviors
· Interaction with and collaboration with medical providers
· Managing adherence
· Manage affective dysregulation (e.g.
anxiety and depression)
· Lifestyle change
· Mobilize social support
· Improvement in coping with stress
· Relapse prevention
Dr. Margaret D. Bischel in Volume
II of Disease State Management Strategies (1999) points out that disease management has these components:
- Implementing guidelines that prompt providers to take appropriate and timely actions
- Screening and prevention
- Decision support systems (MIS) that are user friendly
- Identification of those who are affected by a particular chronic condition, then stratifying to find the riskiest
cases that will benefit the most from aggressive management
- Health promotion and life style adjustments
- Resource and Quality Management/Improvement strategies
- Clinical protocols, pathways or guidelines
- Urgent care, short-term treatment goals and/or observation units
- Clinical and diagnostic guidelines
- Patient education resources and strategies
- Case management
- Coordinating care amongst provider teams
- Tracking patient and provider compliance with the program
- Outcomes measurements, analysis and revision of guidelines as needed
For example, a disease management
program for depression in LTC might involve these elements:
- Early identification of depression (e.g., improved detection at admission)
- Development of focused clinical pathways
- Routine screening of high risk patients
- Educational materials for depression
- Established criteria for referrals
- Educational groups as alternatives to therapy
- Selection of and training in appropriate models (e.g., CT & IPT)
- Improvements in assessment methods (e.g., GDI)
- Improved information about services for those with the disorder
- Preventive education to improve resiliency
- Training and materials for care managers and care givers to improve management
- Identify and implement reliable measures of successful outcomes
Increasingly in the future
treatment for emotional and medical problems will involve integrated care within the context of disease management.
