Public Health Commons^™

The Effectiveness Of Heart Failure Disease Management: Initial Findings From A Comprehensive Program, Janice L. Clarke, David B. Nash

College of Population Health Faculty Papers

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed …

Predicting High Utilization Of Emergency Department Services Among Patients With A Diagnosis Of Psychosis In A Medicaid Managed Care Organization, Tammy K. Girts, Albert G. Crawford, Neil I. Goldfarb, Mark Bachleda, Amy Grogg

College of Population Health Faculty Papers

Studies have demonstrated increased utilization of medical services for patients with behavioral health diagnoses. Medicaid managed care organizations (MMCOs) that operate under behavioral health carve-outs face the challenge of effectively targeting disease management initiatives in the absence of information on behavioral diagnoses. This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. A retrospective cohort analysis was performed using medical and pharmacy claims from an MMCO in Philadelphia, Pennsylvania, to identify patients known to have a diagnosis …

Patient Attitudes Toward Using Computers To Improve Health Services Delivery, Chris N. Sciamanna, Joseph A. Diaz, Puja Myne

College of Population Health Faculty Papers

BACKGROUND:The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients.

METHODS:Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001.

RESULTS:Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). …

Economic And Health Outcomes Of Capsule Endoscopy: Opportunities For Improved Management Of The Diagnostic Process For Obscure Gastrointestinal Bleeding, Neil I. Goldfarb, Amy Phillips, Mitchell Conn, Blair S. Lewis, David B. Nash

College of Population Health Faculty Papers

The estimated annual incidence of gastrointestinal bleeding in the United States is approximately 100 episodes per 100,000 persons, resulting in 300,000 hospitalizations annually. Diagnostic tools such as radiologic studies and endoscopic examination often fail to identify a source of bleeding, resulting in a cycle of repetitive testing over months or even years. Costs associated with the diagnostic process, and with interim treatment for anemia and other symptoms, can be significant. The diagnostic process also takes a toll on the patient, in terms of worry, pain, and discomfort. Capsule endoscopy, a technology that received FDA clearance in August, 2001, consists of …

Strong Partnerships Make Good Partners: Insights About Physician-Hospital Relationships From A Study Of Physician Executives, Marc A. Bard, Michael L. Buehler, Andrew L. Epstein, David B. Nash, John P. O'Connor

College of Population Health Faculty Papers

While physicians are likely to respond favorably in concept to hospital-based disease management and other clinical programs, they are less likely to accept their structural and functional characteristics. Because of their role at the hospital-physician interface, hospital physician executives are often tasked with implementing such programs. Given the challenges involved, a deeper understanding of the role of these executives in building the hospital-physician relationship will therefore be an important contribution. To this end, we surveyed senior physician executives at hospitals and health systems (n = 326), to assess their view of the hospital-physician relationship at their institutions, focusing especially on …

Evaluation Of A Comprehensive Diabetes Disease Management Program: Progress In The Struggle For Sustained Behavior Change, Janice Clarke, Albert Crawford, David B. Nash

College of Population Health Faculty Papers

The successful management of diabetes with a goal of achieving near-normoglycemia requires patients to make multiple lifestyle changes as part of an intensive, complex, and coordinated therapeutic regimen aimed at reducing the risk of complications associated with the disease. The difficulty in creating and sustaining these lifestyle behavior changes is a major stumbling block in achieving the desired therapeutic goal. An underlying assumption of comprehensive disease management is that regular, personal contact with nurses and ancillary health professionals will facilitate these lifestyle behavior changes for program participants. The results of a survey of self-reported data from 750 participants in a …

Measuring Health Status And Quality Of Life In Disease Management Programs, Dea Belazi

College of Population Health Faculty Papers

Current medical practice is largely disease and problem focused, concentrating on the diagnosis and treatment of anatomic or physiologic problems. This approach assumes that physiologic parameters accurately reflect the patient's status of health. It also assumes that, when a patient's disease is ameliorated, his or her quality of life will improve. Many health services researchers find these parameters to be imperfect determinates for good outcomes of patients' perceived health status. However, there are many valid and reliable methods to measure patients' health status and quality of life. Recently available survey tools that measure quality of life are based on modern …