Kash Bita A, Gamm Larry D, Bolin Jane Nelson, Peck B Mitchell
School of Rural Public Health, Texas A&M University System Health Science Center, College Station, Texas, USA.
J Healthc Manag. 2005 Sep-Oct;50(5):297-309; discussion 309-10.
Studies of disease management (DM) have shown that patients who participate in such programs achieve better health status and make fewer emergency room visits. Private and government payers have recently increased their efforts to promote DM initiatives through financial incentives to healthcare providers. This article explores opportunities for administrators of health services organizations (HSO) to promote DM in the current political and economic environment. Our survey of professionals (DM leaders, physicians, and DM nurses) in six DM programs reveals these professionals' assessments of the key players and resources that they deem important to their respective DM programs. They view DM programs as heavily dependent on the support of physicians, nurses, and health plan leaders but relatively less so on the support of HSO administrators- a situation that may suggest opportunities for administrators to take on greater leadership in moving the HSO toward developing DM programs. Survey results also indicate a strong need for the integration of resources such as communication systems, electronic medical records, and DM reporting. Taken collectively, these needs suggest a number of strategies for the administrator to play a larger role in supporting the adoption and effective implementation of DM. In the article, we propose that DM programs can benefit substantially from an administrator who can demonstrate a thorough knowledge of DM-related government and private-payer initiatives and who has the ability to provide leadership to develop and implement viable DM programs. Valued contributions that the administrator should bring to the table include support of standardized DM processes, use of practice guidelines, and provision of pertinent information systems.
疾病管理（DM）研究表明，参与此类项目的患者健康状况更佳，急诊就诊次数更少。近期，私人和政府支付方加大了力度，通过向医疗服务提供者提供经济激励措施来推广疾病管理举措。本文探讨了在当前政治和经济环境下，卫生服务组织（HSO）管理者推广疾病管理的机会。我们对六个疾病管理项目中的专业人员（疾病管理负责人、医生和疾病管理护士）进行的调查揭示了这些专业人员对他们认为对各自疾病管理项目重要的关键参与者和资源的评估。他们认为疾病管理项目严重依赖医生、护士和健康计划负责人的支持，但相对不太依赖卫生服务组织管理者的支持——这种情况可能意味着管理者有机会在推动卫生服务组织发展疾病管理项目方面发挥更大的领导作用。调查结果还表明，迫切需要整合通信系统、电子病历和疾病管理报告等资源。总体而言，这些需求为管理者提供了一些策略，使其能在支持疾病管理的采用和有效实施方面发挥更大作用。在本文中，我们提出，如果管理者能够充分了解与疾病管理相关的政府和私人支付方举措，并具备领导能力来制定和实施可行的疾病管理项目，那么疾病管理项目将受益匪浅。管理者应带来的重要贡献包括支持标准化的疾病管理流程、使用实践指南以及提供相关信息系统。
