Improving quality of care through disease management - Principles and recommendations from the American Heart Association's expert panel on disease management
Improving quality of care through disease management - Principles and recommendations from the American Heart Association's expert panel on disease management
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DOI：
10.1161/01.cir.0000128373.90851.7b
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发表时间：
2004-06-01
期刊：
影响因子：
37.8
通讯作者：
Shine, K
中科院分区：
文献类型：
--
作者：
Faxon, DP;Schwamm, LH;Shine, K
疾病管理已成为提高患有一种或多种慢性病患者的护理质量的一种潜在战略，而心血管疾病是许多正在进行的和潜在的努力的重点。医疗界对探索疾病管理策略的兴趣很大程度上是由于心力衰竭领域的成功，以及公共和私人支付者对有效管理慢性病和控制其日益增长的成本的日益增长的渴望。对疾病管理策略的兴趣也在一定程度上受到美国人口老龄化的推动，这创造了对有效的成本和高质量护理模式的日益增长的需求。经济压力和提供更高质量医疗服务的愿望迫使私营部门雇主、州政府和联邦政策制定者审查并越来越多地采用疾病管理技术。在联邦一级，联邦医疗保险计划建立了几个示范项目，涉及国会近年来批准的疾病管理。3、4这些示范项目包括联邦医疗保险发起的疾病管理演示、联邦医疗保险BIPA(联邦医疗保险、医疗补助和2000年芯片福利改善和保护法)疾病管理演示，以及联邦医疗保险协调护理演示，所有这些项目都针对患有慢性病(包括心脏病)的患者。2003年11月下旬，国会通过了《2003年医疗保险处方药、改进和现代化法案》(HR 1)。5这被认为是自1965年医疗保险计划成立以来最广泛的改革。新法律包含3个章节，规定了疾病管理举措。第一，传统医疗保险下的自愿慢性护理改善，赋予医疗保险和医疗补助服务中心(CMS)直接与疾病管理公司和其他合格实体签订合同的权力，以帮助管理慢性病。在最初的3年试验期之后，如果一个或多个慢性护理计划被认为是成功的，CMS可以开始在全国范围内实施这些计划。联邦医疗保险管理绩效演示要求CMS建立一个为期3年的示范计划，以促进护理的连续性，帮助稳定医疗条件，防止或最大限度地减少慢性病的急性加重，并减少不利的健康后果，而消费者导向的慢性门诊服务示范项目要求部长建立不少于3个示范项目，以评估改善向患有慢性病的联邦医疗保险受益人提供的护理质量的方法，并减少原本将根据联邦医疗保险计划代表患有此类慢性病的个人进行的支出。5疾病管理可能是通过提高护理质量、遵守指南和其他护理规程以及获得保健服务来加强心血管疾病和中风患者及其风险患者的治疗的有效手段。疾病管理也可能是通过在降低成本的同时保持或提高质量来提高提供保健服务的效率的有效手段。有相当多的临床证据检验了心血管疾病和中风疾病管理策略的使用。6-19 AHA目前参与了许多属于疾病管理计划和支持服务定义的倡议(见下文讨论)。
Disease management has emerged as a potential strategy to enhance the quality of care received by patients suffering from one or more chronic conditions, and cardiovascular diseases are the focus of many such ongoing and potential efforts. Much of the interest within the healthcare community in exploring disease management strategies has been fueled by the success in the heart failure arena and by the growing desire of public and private payers to effectively manage chronic conditions and to control their increasing costs. The interest in disease management strategies also is driven in part by the United States’ aging population, which is creating increasing demand for effective cost and quality care models. Economic pressures and the desire to provide better-quality care have compelled private-sector employers, state governments, and federal policymakers to examine and, increasingly, to employ disease management techniques. At the federal level, the Medicare program has established several demonstration projects involving disease management that Congress authorized in recent years. 3, 4 These demonstration projects include the Medicare Capitated Disease Management Demonstration, the Medicare BIPA (Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000) Disease Management Demonstration, and the Medicare Coordinated Care Demonstration, all of which target patients with chronic diseases, including heart disease. In late November, 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (HR 1). 5 This is considered the most extensive reform to the Medicare program since its inception in 1965. The new law contains 3 sections that establish disease management initiatives. The first, Voluntary Chronic Care Improvement under Traditional Medicare, provides the Centers for Medicare and Medicaid Services (CMS) with the authority to contract directly with disease management companies and other qualified entities to help manage chronic illness. After an initial 3-year pilot period, CMS may begin nationwide implementation of one or more chronic care programs if the programs are deemed successful. The Medicare Care Management Performance Demonstration requires CMS to establish a 3-year demonstration program to promote continuity of care, help stabilize medical conditions, prevent or minimize acute exacerbations of chronic conditions, and reduce adverse health outcomes, and the Demonstration Project for Consumer Directed Chronic Outpatient Services requires the Secretary to establish no fewer than 3 demonstration projects to evaluate methods that improve quality of care provided to Medicare beneficiaries with chronic conditions and that reduce expenditures that would otherwise be made under the Medicare program on behalf of individuals with such chronic conditions. 5 Disease management may be an effective means to enhance the treatment of individuals suffering from and at risk for cardiovascular disease and stroke by increasing the quality of care, adherence to guidelines and other care protocols, and access to healthcare services. Disease management may also be an effective means to improve the efficiency of the delivery of healthcare services by maintaining or improving quality while reducing costs. There is a considerable body of clinical evidence examining the use of disease management strategies for cardiovascular disease and stroke. 6–19 The AHA currently is involved in many initiatives that fall within the definition of disease management programs and support services (see discussion below).