Disease ManagementOberlander J: the partisan divide – the McCain and Obama plans for U.S. health care reform. New Engl J Med. 2008;359:781-784. President Obama says disease management is an element of health care reform.
LinkGibbons RJ, Jones DW, Gardner TJ, Goldstein LB, Moller JH, Yancy CW: The Americah Heart Asscoation’s 2008 statement of principles for healthcare reform. Circulation 2008;118:0-0 It includes support for disease management.
LinkMattke S, Martorell F, Sharma P, Morse LK, Lurie N, Lara M: Rand Working Paper on Estimating the Impact of Improving Asthma Treatment. Disease management for asthma works – sometimes.
LinkEsposito D, Brown R, Chen A, Schore J, Shapiro R: Impacts of a disease management program for dually eligible beneficiaries. Health Care Finan. Review. Fall 2008;30(1):27-45. Preliminary report on Lifemaster’s experience with fee-for-service dual eligibles in Florida. Medicare expenditures were reduced by 9.6% among persons with chronic heart failure. Look for follow-up reports, the news gets better.
LinkBadamgarav E, Weingarten SR, Henning JM: Effectiveness of disease management programs in depression: A systematic review. Am J Psychiatry 2003;160:2080-2090. It improves clinical outcomes but may increase health care utilization and treatment costs.
LinkHebert PL Sisk JE, Wang JJ et al: Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community. Ann Int Med 2008;149(8): 540-548. It didn’t save money but the dollars spent were a wise investment.
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Sidorov J: Reduced Health Care Costs Associated With Disease Management for Chronic Heart Failure: A Study Using Three Methods to Examine the Financial Impact of a Heart Failure Disease Management Program Among Medicare Advantage Enrollees. J Cardiac Failure. 2006; 12(8):594-600. Three methods were used to assess the costs from a disease management program for heart failure. It appears money was saved.
LinkCook PF, Emilozzi S, Waters C, Hajj DE: Effects of telephone counseling on antipsychotic adherence and emergency department utilization. Am J Man Care. 2008;14:841-846. If you can connect with persons with severe mental illness, good things happen.
LinkMonane M, Matthias DM, Nagle BA, Kelly MA: Improving prescribing patterns for the elderly through an online drug utilization review intervention. JAMA 1998;280(14): 1249-1252. Pharmacists using a registry can do telephonic disease management.
LinkHunkeler EM, Meresman JF, Hargreaves WA et al: Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000;9(8):700-708. Randomized clinical trial examining the impact of ten 6 minutes calls over 4 months by nurses. It led to a 12% improvement in the number of persons with depression.
LinkGeyman JP: Disease management: Panacea, another false hope or something in between? Ann Fam Med 2007;5:257-260. No… something worse than false hope: ‘It is much more likely that the current enthusiasm among employers and insurers for outsourced disease management programs will end up as just one more policy failure, undermining primary care and delaying increasingly urgent health care reform.’ Ouch.
LinkBooth CM, Mackillop WJ: Translating new medical therapies into societal benefit. JAMA 2008;300(18): 2177-2179. It’s not only possible to study the impact of health care interventions outside of randomized studies, it’s necessary.
LinkColeman EA, Parry C, Chalmers S, Min S: The care transitions intervention. Arch Int Med 2006;166: 1822-1828. How about disease management to help persons from being unnecessarily re-hospitalized?
LinkPrimary Care/Medical Home.The CMS Web Site for the Medicare Medical Home Demonstration.
LinkThe NCQA scoring system for it’s Medical Home program.
LinkIglehart JK. No place like home – testing a new model of care delivery. New Engl J Med 2008;359:1200-1202. A summary of the Medical Home and the upcoming CMS demo.
LinkRosenthal MB: Beyond pay for performance – emerging models of provider-payment reform. New Engl J Med 2008;359:1197-1200. And where stands P4P in all this? You can find out here.
LinkFisher ES: Building a medical neighborhood for the medical home. New Engl J Med. 2008;359:1202-1205. There are many pitfalls between the theory and the successful clinical practice of a medical home.
LinkCaban MD, Rand CS, Powe NR et al: Why don’t physicians follow clinical practice guidelines. JAMA 1999;282(15): 1458-1465. Lack of awareness, lack of confidence, disagreement that recommendations will work, inertia and external barriers.
LinkWeiss KB, Wagner R: Performance measurement rhought audit, feedback and profiling as tools for improving clinical care. 2000;118:s53S-58S. Measuring physician performance is a lot harder than it looks.
LinkPalacia H: The quest for quality: Does network participation matter? J Gen Int Med 2007;22(10): 1482. What is the impact of group size (the number of physicians) and network affiliation on HEDIS measures of quality? Size doesn’t necessarily count.
LinkLandon BE, Reschovsky J, Blumenthal D: Changes in career satisfaction among primary care and speciality physicians, 1997-2001. JAMA 2003;289(4): 442-449. It’s not money. Physicians live by more than bread alone.
LinkStrum R: Effect of managed care and financing on practice constraints and career satisfaction in primary care. JABFM 2002;15(5): 367-377. That’s right, it’s NOT the money. Plus, physicians hate being gatekeepers, which may have implications for the medical home.
LinkHauer KE, Durning SF, Kernan WN: Factors associated with medical students’ career choices regarding internal medicine. JAMA 2008;300(10):1154-1164. Lifestyle is a factor in medical students’ choices about a career in primary care.
LinkLee TH, Bodenheimer T, Goroll AH, Starfield B, Treadway K: Redesigning primary care. Perspective roundtable (Video). How academics would redesign primary care.
LinkKane, CD: Physician Marketplace Report. The practice arrangements of patient care physicians, 2001. Most are in small groups, which will be a key factor in health care reform.
LinkOkie S: Innovation in primary care – staying one step ahead of burnout. New Engl J Med. 2008;359:2305-2309. What larger group practices are doing.
LinkJaber R, Braksmajer A, Trilling JS: Group visits: A qualitative review of current research. JABFM 2006;19:276-290. A literature review found considerable variation in the reports but there is enough evidence to suggest group visits are a ‘promising’ approach.
LinkGrumbach K, Bodenheimer T: Can health care teams improve primary care practice? JAMA 2004;291(10):1246-1251. Teams are one of the elements of the medical home. Read all about it here.
LinkStrycker LA, Glasgow RE: Assessment and enhancement of social and community resources utilization for disease self-management. Health Promotion Practice. 2002;3(3):374-386. One of the elements of the patient centered medical home is community linkages. This describes on example.
LinkBodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002; 288(14): 1775-1779. One of the seminal articles on the phenomenon of the medical home from superstars on the topic. No review is complete without this citation.
LinkGrumback K, Bodenheimer T: A primary care home for Americans. JAMA 2002;288(7):889-893. All arguments on behalf of relying on primary care to fix all that ails health care is here.
LinkPham H, Schrag D, O’Malley AS, Wu B, Bach PB: Care patterns in Medicare and their implications for pay for performance. New Engl J Med. 2007; 356: 1130-1139. Medicare FFS beneficiaries have many physicians involved in their care and indentifying the responsible physician is a challenge.
LinkGlabman M: Home, (not so) sweet, medical home. Managed Care Dec. 2008: 28-30. News report summary of the audience reaction to a DMAA Conference presentation about the medical home.
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Rosenbaum L: Living unlabeled – diagnosis and disorder. New Engl J Med 2008;359:1650-1653. How modern medicine demands a diagnosis while physicians struggle to give answers in a world of uncertainty.
LinkAHRQ: Integrating chronic care and business strategies in the safety net. A ‘how to’ tool kit on implementing the chronic care model in your clinical practice.
LinkSidorov JE: The Patient-Centered Medical Home For Chronic Illness: Is It Ready For Prime Time? Health Affairs 2008;27(5):1231-1234. Maybe not.
LinkPatient Centered CareSepucha KR, Fowler FJ, Mulley AG: policy support for patient-centered care: the need for measurable improvements in decision quality. Health Affairs 2004; 10.1377/hlthaff.var.54 A review of the topic and policy implications.
LinkObesityLudwig DS, Nestle M: Canb the food industry play a constructive role in the obesity epidemic? JAMA 2008;300(15):1808-1811. The answer is no.
LinkBeuther DA, Weiss ST, Sutherland ER: Obesity and asthma. Am J Resp and Crit Care Medicine. 2006;174:112-119. Here’s why the two seem to travel together.
LinkConsumer Directed Health PlansDixon A, Greene J, Hibbard J: Do consumer directed health plans drive change in enrollees’ health care behavior? Health Affairs 2008;27(4): 1120-1131. The answer is yes, but not that much.
LinkFederal and Policy ReportsFrom NCQA: State of Health Care Quality in the US, 2008
LinkFrom Milliman, Inc: Cost trends for chronic condition cohorts with Medicare benefits.
LinkFrom CMS: A Fact Sheet on non-payment by CMS for ‘never events.’
LinkFrom CMS: A PowerPoint overview of the Medical Home Demonstration.
LinkFrom the Robert Wood Jonson Foundation: Ginsberg PB: High and rising health care costs. What is causing high health care costs? Find out here.
LinkFrom the CBO: Key Issues in Analyzing Major Health Insurance Proposals. Everything you wanted to know about the cost vs. benefit.
Link From the CBO: Budget Options, Volume 1: Health Care. Companion piece to Key Issues above.
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From the U.S. Senate Finance Committee Chair: Call to Action. Health Reform 2009. Read what Senator Baucus thinks should happen in 2009.
LinkFrom the Institute of Medicine: Report Brief* December 2008. HHS in the 21st Century: Charting a New Course for a Healthier America. Health and Human Services needs to be reorganized.
LinkFrom HHS Inspector General: Generic Drug Utilization in the Medicare Part D Program. Generics are one reason why it’s under cost.
LinkFrom Medicare: Medical Home Questions and Answers
LinkFrom GAO: Medicare Part B Imaging Service: Rapid Spending Groth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices. That’s right, managed care style utilization management using pre-authorization.
LinkFrom HHS. Physician Quality Reporting Initiative. 2007 Reporting Experience. See what CMS has to say about it’s fee-for-service physician pay for performance program.
LinkFrom the Federal Reserve Board. Wellpoint Inc: Wellpoint can be a “bank” even though it provides disease management services. Confused? Don’t be.
LinkPolicy, Variation, Technology, Value, Dollars and QALYsMcGlynn EA, Asch SM, Adams J et al: The quality of health care delivered to adults in the United States. New Engl J Med. 2003;348:2635-2646. It’s not very good.
LinkSirovich BE, Gottlieb DJ, Welch G, Fisher ES: Variation in the tendency of primary care physicians to intervene. Arch Int Med 2005;165: 2252-2256. Physicians in high spending areas spend more money when it comes to health care.
LinkDavis K: Slowing the growth of health care costs – learning form the international experience. New Engl J Med 2008;359:1751-1755. We have much to learn from the lands across the pond.
LinkBaker LC, Atlas SW, Afendulis CC: Expanded use of imaging technology and the challenge of measuring value. Health Affairs 2008;27(6):1467-1478. High dollar radiology brings benefits and cost. How much benefit at just how much cost is a better question.
LinkEddy DM, Schlessinger L, Kahn R: Clinical outcomes and cost effectiveness of strategies for managing people high risk for diabetes. Ann Int Med 2005;143(4): 251-264. Lifestyle modification to prevent diabetes is not necessarily a good deal.
LinkFoster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW: the incidence and severity of adverse events affecting patients after discharge form the hospital. Ann Int Med 2003;138:161-167. The likelihood of problems after hospital discharge is surprisingly common.
LinkMoore C, MCGinn T, Halm E: Tying up loose ends. Discharging patients with unresolved medical issues. Arch Intern Med 2007;167:1305-1311. Patients are being rushed to discharge with unresolved medical problems that are not being addressed once they are in the outpatient setting.
LinkDentzer S: From the Editor. Health Affairs. doi: 10.1377/hlthaff.28.1.w87. Links here to some jousting over the orthodoxy that Dartmouth Atlas is the end-all to understanding the basis for health care cost variation.
LinkCarey TS, GarrettJ: Patterns of Ordering Diagnostic Tests for Patients with Acute Low Back Pain Ann Int Med 1996;125(10):807-814. Considerable variation in how physicians approach the decision on whether to get x-rays for low back pain.
LinkHack JS: Speaking truth to power: the need for and perils of health policy expertise in the White House. You can have too much of it and make a mess of things. New Engl J Med. 2008;359:1085-1087.
LinkGalvin RS: Still in the game – harnessing employer inventiveness in US health care reform. New Engl J Med 2008;359:1421-1423
Katz MH: Banning tobacco sales in pharmacies. JAMA 2008;300(12):1451-1453. Tobacco shouldn’t be in there. Find out why.
Link Diabetes mellitus
Rowe S, MacLean CH, Shekelle PG: Preventing visual loss from chronic eye disease in primary care. JAMA 2004;291(12):1487-1495. The evidence underlying the notion that all persons with diabetes should have an annual examination is thin.
LinkBolen S, Feldman L, Vassy J: Systematic review: Comparative effectivenss and safety of oral medications for type 2 diabetes mellitus. Ann Int Med. 2007;147(6):386-399. Pending further research, the old generic drugs are just as good as the new expensive drugs.
LinkPeyrot M, Rubin RR: Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997;20(4):585-590. It’s considerable.
LinkDrugs/PharmacyOwne G, Balfour D, Cohen J et al: Prescription benefit design: Perspectives, reimbursement issues and future trends. Am J Man Care 2004;10:s420-s423. Short sweet description of the rationale behind tiering, preauthorization and the problem of biologicals.
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Kesselhaime AS, Misono AS, Lee JL et al: Clinical equivalence of generic and brand-name drugs used in cardiovascular disease. JAMA 2008;300(21): 2514-2526. Many studies show generics are just fine. Many physician-written editorials say docs should be able to prescribe non-generics whenever they want.
LinkAlexander GD, Sehgal NL, Moloney RM, Stafford RS: National trends in the treatment of type 2 diabetes mellitus, 1994-2007. Arch Int Med 2008;168(19):2088-2094. Many pills. Much cost. Are we getting our money’s worth?
LinkAustin RP: Polypharmacy as a risk factor in the treatment of type 2 diabetes. Diabetes Spectrum 2006;19:13-16. It’s really easy for persons with diabetes to end up on too many pills.
LinkMalone DC, Haupert H, Hansten P, Duncan B, Van Bergen RC, Solomon SL and Lipton RB: Assessment of potential drug-drug interactions with a prescription claims data base. Am J of Health-System Pharmacy 2005;62(19): 1983-1991. How pharmacy benefit managers (PBMs) can use their data bases.
LinkRaschke RA, Gaollihare B, Wunderlich TA et al: A computer alert system to prevent injury from adverse drug events. JAMA 1998;280(15): 1317-1320. Preliminary report on the utility of a computerized system to spot adverse drug reactions (ADEs). Has information of baseline rates of ADEs.
LinkPeng C, Glass PA, Trilli LE, Hayes-Hunter J, Good CB: Incidence and severity of potential drug-dietary supplement interactions in primary care. Survey in outpatient veterans clinics. Arch Int Med 2004; 164(6):630-636
LinkQato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Tessler Lindau S: Use of prescription and over the counter medications and dietary supplements among older adults in the United States. Survey based study of use of prescription, OTC and herbal meds among older adults. JAMA 2008;300(24):2867-2878
LinkEHRsTolbert CJ, Gilbert M: Race, place and information technology. Urban Affairs Review. 2006;41(5): 583-620. Do you worry about health IT exacerbating disparities in access to health care? You should.
LinkBaker L, Wagner TH, Singer S, Bundorf MK: Use of the internet and e-mail for health care information. JAMA 2003;289:2400-2406. Survey found ‘use of the Internet for health information is universal or that the Internet strongly influences health care utilization.’
LinkMoyer CA, Stern DT, Dobias KS, Cox DT, Katz SJ: Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Man Care 2002;8:427-433. Survey says patients and docs are open to the concept.
LinkHassol A, Walker JM, Kidder D et al: Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc 2004;11:505-513. Patients that USE e-messaging like it but physicians were more likely to prefer telephone communication.
LinkFischer MA, Vogeli C, Stedman M, Ferris T, Brookhart MA, Weissman JS: Effect of electronic prescribing with formulary decision support on medication use and cost. Arch Int Med 2008; 168(22): 2433-2439. This changes physician prescribing habits but only in the single percent range.
LinkGrossman JM, Gerland A, Reed MC, Fahlman C: Physicians’ experiences using commercial e-prescribing systems. Health Affairs 2007;26(3): w393-w404. Much work remains in medication lists, decision support, formulary data and prescription transmittal.
LinkHollingworth W, Devine EB, Hansen RN: The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study. A Am Med Inform Assoc. 2007;14:722-730. Good news is that e-prescribing doesn’t increase time, but bad news is that it doesn’t save time.
LinkDesRoches CB, Bampgell EG, Rao SR: Electronic health records in ambulatory care – a national survey of physicians. 2008;359:50-60. A survey of over 2700 physicians indicating 13% uptake rate, satisfaction among those using it and cost being a barrier for those not using it.
LinkLinder JA, Ma J, Bates DW, Middleton B, Stafford RS: Electronic health record use and the quality of ambulatory care in the United States. Arch Int Med 2007;167(13): 1400-1405. Using the National Ambulatory Medical Care Survey, the authors were unable to find an association between quality and use of EHRs.
LinkBaron RJ, Faben E, Schiffman M, Wolf E: Electronic health records: Just around the corner? Or over the cliff? Ann Int Med 2005;143:222-226. A description of the travails of implementing an EHR in a busy primary care practice.
LinkWelch WP, Bazarko D, Ritten K, Burgess Y, Harmon R, Sandy LG: Electronic health records in four community physician practices: impact on quality and cost of care. J Am Med Inform Assoc 2007;14:320-328. Real world study of what happened: not much.
LinkSidorov J: It ain’t necessarily so: the electronic health record and the unlikely prospect of reducing health care costs. 2006;25(4):1079-1085. There are too many peer-reviewed publications that say the EHR doesn’t save money or improve quality.
LinkVerghese A: Culture Shock – patient as icon, icon as patient. New Engl J Med. 2008; 359:2748-2751. Opinion piece on how information technology is causing physicians’ traditional skills to wane.
LinkKo Y, Abarca J, Malone DC et al: Practitioners’ views of computerized drug-drug interaction alerts in the VA system. J Am Med Inform Assoc 2006; 14:56-64. Survey results that say they like it but there’s room for improvement.
LinkMedical Facts
Depression/Anxiety
Whooley MY, Simon GE: Managing depression in medical outpatients. 2000;343:1942-1950. Drugs and counseling are equally effective approaches to the management of depression.
LinkWalkup JT, Albano AM Piacentini J: Cognitive behavioral therapy, Sertraline or combination in childhood anxiety. New Engl J Med. 2008;359: 2753-2766. Easy: drugs. Just as effective but more expensive: counseling. Best: both.
LinkHeart Disease
Ridker PM, Danielson E, Fonseca AH et al: Rosuvastatin to prevent vascular events in men and womn with elevated C-reactive protein. New Engl J Med 2008;359:2195-2207. This is the Jupiter Study that shows that ‘treating’ an elevated C-reactive protein reduces the incidence of cardiovascular events in persons without a prior history of heart attack.
Link. The editorial from the same study is here.
LinkHirschfield GM, Pepys MB: C-reactive protein and cardiovascular disease: new insights form an old molecule. QJM 2003;96: 793-807. Just what is “C-reactive protein” you ask? Find out here.
LinkRidker PM, Rifai N, Clearfield M: Measurment of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. New Engl J Med 2001;344:1959-1965. In retrospect, having an elevated C-reactive protein seemed to predict the likelihood that lipid lowering therapy would prevent heart attacks. This is the seminal study behind the Jupiter Study.
LinkBeleslin BD, Stepanovic J, Djordjevic-Dikic A et al: Stress echocardiography in the detection of myocardial ischemia. Head- to-head comparison of exercise, dobutamine, and dipyridamole tests. Circulation 2004;90:1168-76 The accuracy of stress tests – taken for granted by millions of people – ranges from 77 to 87%. It’s not 100%.
LinkOvarian Cancer
Cannistra SA: Cancer of the Ovary. New England J of Med 2004;351: 2519-2529. This is a bad cancer that is quite lethal when it comes back.
LinkAsthma:
Lipworth BJ: Systemic adverse effects of inhaled corticosteroid therapy. Arch Int Med 1999;159(9):941-955. Includes osteoporosis, cataracts and glaucoma.
LinkScanlon PD, Connett JE, Wise RA et al: Loss of bone density with inhaled triamcinolone in lung health study II. Am J of Resp and Crit Care Med. 2004;170:1302-1309. Inhaled steroids cause osteoporosis.
LinkMasoli M, Weatherall M, Holt S, Beasley R: Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Salmeterol plus inhaled steroid beats inhaled steroid alone.
LinkSpitzer WO, Suissa S, Ernst P et al: The use of beta-agonists and the risk of death and near death from asthma. New Engl J Med 1992;326:501-506. Problems from over-exposure to beta agonists in asthma is not new news.
LinkNelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinksy PM, SMART Study Group: The Salmeterol multi-center asthma research trial. CHEST 2006;129:15-26. Small increase in deaths from long acting beta agonists in this randomized clinical trial.
LinkJohnson M: the Beta adrenoceptor. Am J of Resp and Crit Care Med 1998;158(5): s146-s153. How do inhalers work for asthma? How do beta blockers work in heart disease?
LinkTeng JK, Kwan CM, Lin LJ, Tsai M et al: Down-regulation of beta-adrenergic receptors on monomuclar leukocytes induced by dobutamine treatment in patients with congestive heart failure. Eur Heart J 1993;14(1): 1349-1353. Why stimulating beta receptors excessively leads to problems.
LinkDickinson BD, Altman RD, Deitchman SD, Champion HC and the Counceil of Scientific Affairs America Medical Association. Safety of over the counter inhalers for asthma. Chest 2000;118:522-526. Not good for anything other than mild asthma.
LinkEneli IU, Skybo T, Camargo CA: Weight loss and asthma: a systemiatic review. Thorax 2008; 63:671-676. Weight loss can help the symptoms of asthma.
LinkBlood Tests
Narain S, Richard HB, Satoh M et al: Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting. Arch Int Med 2004;164(22):2435-2441. This is an example of how blood tests can fail to make a diagnosis.
LinkX-Rays
Marks PM, Holmgren EB, Fox AJ, Patel S, von Kummer R, Froehlich J: Evaluation of early computed tomographic findings in acute ischemic stroke. CStroke 1999;30:389-392. CAT scans miss a surprising number of strokes.
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