From outcomes research to disease management: a guide for the perplexed

Article Abstract:

Disease management is a new, more systematic, population-based approach to providing medical care. Disease management depends on outcomes management: the ongoing measurement of outcomes and their correlation with treatment. The outcomes measured may be clinical improvement, cost-effectiveness, or quality-of-life issues. Disease management requires that studies evaluate treatments as delivered in real-world situations. These types of studies are relatively new in medical research. Cost-effectiveness may also prove difficult to determine because the numbers vary according to whether short-term or long-term outcomes are studied, which outcomes are measured, the timing of the intervention, and to whom it is applied. Evaluation demands an organizational structure in which outcomes can be uniformly assessed, electronically processed, and analyzed. The theory behind disease management is that optimal therapies can be determined in this way. Whether disease management improves care is unknown because the concept is too new for comparison studies.

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Disease management: new wine in new bottles?

Article Abstract:

Disease management offers both advantages and disadvantages over the current health care system. Disease management is a systematic, population-based approach to health care intended to improve health care outcomes while containing costs. It requires a managed care structure. The problem is that quality of care and patient benefit can take second place to profits. For example, drug companies may encourage less than optimal drug regimens that involve their product, or managed care programs may choose not to offer comprehensive AIDS care or diabetes care because such programs will attract patients with these costly illnesses. Disease management also encourages specialized care for certain conditions, which can contribute to fragmenting delivery of care as specialists develop separate networks. On the other hand, disease management fosters a systematic, team approach to care. This can improve quality of care and medical decision making while relieving the pressure on individual doctors to achieve perfection.

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The imperative of outcomes analysis: an integration of traditional and nontraditional outcomes measures

Article Abstract:

An infrastructure for outcomes assessment has been designed and proposed for implementation at the Kaiser Permanente Medical Centers in the Northern California region. The initial goal was to identify outcomes relevant to nursing care, but the need for a more comprehensive approach became evident. The proposed infrastructure incorporates wellness-related measures as well as the more familiar illness-related outcomes. Fourteen outcome indicators have been identified in the broad categories of functional status, health care knowledge and level of involvement, and psychosocial well-being.

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