Abstract
This chapter describes the broad array of information technologies currently used in programs that manage individuals with chronic diseases and discusses evaluation strategies to assess the impact of implementing programs that incorporate such technologies. More specifically, it describes the three components of a chronic disease management program and then details the technologies commonly used in each component. Three evaluation designs well-suited to measure DM program effectiveness are also discussed. The intent of this chapter is to educate readers on the range of approaches to incorporating information technology into chronic disease management and the most appropriate evaluation designs that will strengthen the understanding of which approaches are most successful.
TopAs the burden of chronic disease escalates, it has become clear that health care systems designed to deliver acute care do not meet the needs of the chronically ill population (McGlynn et al., 2003). Chronic conditions require ongoing, multi-disciplinary care that includes more frequent patient contact to assess changes in clinical status. Chronic conditions also require unique forms of care, such as patient education on self-management. In addition, assessments take place at both the patient level to inform the management of individual cases, and at the population level to identify trends that should be addressed systematically. These three characteristics create substantial opportunity for information technology (IT) to improve the efficiency and effectiveness of chronic disease management efforts.
Many stakeholders have responded to the evidence that chronic care requires improvement. In the United States, the system with which the authors’ are most familiar, a billion-dollar commercial industry has emerged, which offers stand-alone programs designed to address current shortcomings in chronic care; commercial health insurers as well as the Medicare and Medicaid programs have contracted with these companies to manage their members with chronic illnesses (Linden & Adler-Milstein, 2008). In parallel, traditional health care delivery systems are rethinking how to deliver care that meets the needs of the chronically ill population. As a result, a variety of stakeholders currently sponsor disease management programs. An individual care provider or medical group can initiate a program to manage the chronically ill patients in their panel. A private or public/government payer can implement a program to manage their chronically ill members or beneficiaries; this can be done by the payer itself or by contracting with a third party vendor to provide this service. Finally, integrated delivery systems and staff model Health Maintenance Organizations like the US-based Kaiser system can offer disease management. The type of sponsor influences the program structure and the associated IT tools that are incorporated. For example, a provider-sponsored program can leverage an electronic medical record system to support the program while a payer-sponsored program may not have access to this clinical technology.
Key Terms in this Chapter
Self-Management Tools: Topic-based health information applications designed to educate users on symptoms, conditions, behaviors, and treatments to improve health status and encourage appropriate utilization of medical services
Clinical Decision-Support Tools: Applications that support clinical staff in delivering evidence-based care to patients with specific conditions and symptoms via reminders, alerts, and access to related clinical information
Remote Telemonitoring: Frequent electronic measurement and reporting of symptoms and clinical indicators by patients outside of a medical setting to assess health status and risk of near-term health episode
Predictive Modeling Software: Analytic tool that applies available data to stratify people according to medical need and risk of future medical service utilization
Electronic Medical Record: Electronic repositories of all health-related patient data that can be accessed in real-time by clinical staff members to assess clinical status, health history, etc.
Disease Registry: Databases that capture and provide access to condition-specific information for a group of people with a given condition to support organized care management
Disease Management: A coordinated, comprehensive, and systematic approach to managing chronic disease-related behaviors and care by engaging patients and/or their providers
Personal Assessment Tools: Survey-based tools that assesses health history and current health factors to determine health status and risk for chronic disease