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Read All About It: The Disease Management Journal

Posted Dec 02 2008 3:08am
While the Disease Management Care Blog has also been distracted by the national politics, turpitude in the Governor's Office, sky rocketing gasoline costs and the re-discovery of Mike the Headless Chicken, the good news is that I was also trapped on Interstate Route 80 sans internet access. I made the best of the desolation by turning up the volume on that single country radio station and breaking out the latest issue of the Disease Management, the official Journal of the DMAA, the Care Continuum Alliance. Knowing that many busy readers of the DMCB don't have the benefit of a Route 80 and must tend to endless meetings, emails and reports, I offer up this very brief bulleted and opinionated summary of the articles that you may not have time to read. I offer this up so that readers can check out which nuggets may deserve closer scrutiny for themselves.

Kudos, by the way, to the editors for making this particular issue freely available on line.

Carver, JR, NG A, Meadows AT, Vaughn L: Cardiovascular late effects and ongoing care of adult cancer survivors.

This is an opinion piece on the long term follow up of survivors of cancer that have been treated in ways known to increase the risk of cardiac disease: anthrcylcines, cisplatin, trastuzumab or mantle radiation. Absent any good clinical trials, they admittedly use "arbitrary" criteria to recommend echocardiography under a number of higher risk scenarios.

Bottom line: While a reasoned approached, it's hard to see any big connection with usual disease management programs; long term survivors of cancer are usually not included. That being said, it may warrant a place in the knowledge base that DM nurses can turn to when they are dealing with cardiovascular risk in a cancer survivor.

Macstravic S: Therapeutic specificity in disease management evaluation.

Dr. MacStravic reminds us that disease management programs' impact extends far outside the bounds of the chronic condition itself. There are benefits for other co-morbidities, multiple patient behaviors and worksite measures, including absenteeism and employee retention.

Bottom line: Most of us in the industry know this already, but it's nice to have it in black and white.

Kimura J, DaSilva K, Marshall R: Population management, systems-based practice and planned chronic illness care: Integrating disease management competencies into primary care to improve composite diabetes quality measures.

This is a description of the implementation of NOT disease management but the Chronic Care Model into Harvard Vanguard. Based on a pre-post analysis the 11,896 diabetic patients with at least one internal medicine visit, the authors concluded their program worked.

Bottom line: it worked if you change the title from disease management to medical home, if you accept single digit improvements as the definition of "worked" and if you think Harvard Vanguard's setting is remotely similar to other primary care settings that take care of persons with diabetes.

Want J, Kamas G, Nguyen T-N: Disease management in the frail and elderly popuatlion: Integration of physicians in the intervention.

This is from the folks at Physician Health Partners with the somewhat unclear involvement of Pfizer Health Solutions. Care managers were installed in a IPA. Unfortunately, I can't tell if the intervention was really responsible for the improvement seen in the N=569 patients because the analysis of functional, behavioral,clinical status and quality of life used the participants' baseline data as the comparator. The DMCB wonders if this could be an example of regression to the mean.

Bottom line: Read this article more for the insights about a DM company getting case managers into an IPA. There are other studies using better comparators out there that already show this model results in good outcomes and reductions in claims expense.

Sylvia ML, Griswold M, Dunbar L, Boyd, CM, Park M, Boult C: Guided care: Cost and utilization outcomes in a pilot study.

Half of the four physicians were assigned an RN while the other half provided usual care. Guess which had lower claims expense for their frail older patients? Unfortunately, there weren't enough patients to achieve statistical significance, but the savings of approximately $1400 over 6 months sure seemed financially significant.

Bottom line: This is a nice compliment to Want et al's study above: getting case managers to partner with physicians = results. Like Want's study, the implication is that if insurers cover the cost of these nurses, good things happen.

Fetterolf D, Olson M: Opt-in Medical Management strategies.

Want an excellent review from Matria about why you should talk you clients out of using an opt-in approach?

Bottom line: Look no further.

Moyneur E, Bookhart BK, Mody SH, Fournier A-A, Mallett D, Duh MS: The economic impact of pre-dialysis epoetin alfa on health care and work loss costs in chronic kidney disease: an employers' perspective.

Patients who got "epo" in the months prior to starting dialysis subsequently had lower claims expense compared to those who didn't. The article's authors included persons from Ortho Biotech (manufactures Procrit). It was was accompanied by an editorial from Jefferson's Department of Health Policy, which points out the article lacked hemoglobin results data and that the population was sparsely described. It's hard to know if the outcomes were the result of the EPO versus self selection bias or other interventions that may be signaled by access to EPO.

Bottom line: It sure is hard to use just claims data to understand what how epo performs in an insured population, but the editorial has a point: we need a more studies that help us better understand the role of EPO in this and other populations.
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