Disease management unique to each facility

Start process by developing goals and objectives

There is no blueprint’ for a disease management program, says Michael Tocco, RPh, MEd, president of ICPR: Integrated CARE Group in Waltham, MA. Each program must be tailored to fit the disease and the managed care organization or health care facility for which it is designed. However, there are common components in any successful disease management program that should be evaluated for inclusion in your particular one, he says.

"The path an organization follows to a successful disease management program will vary, but fundamentally the components — patient registries, treatment algorithms, provider and patient management, measurement and quality improvement plans — are the same," says Tocco.

Tocco, who has set up several disease management programs for various organizations, advises health care facilities to begin by setting up a core working group that will oversee the entire process. Members would include an administrator, a primary care physician, a specialist in a target disease state, a pharmacist, and a nurse.

The core group establishes the goals and objectives for the program. "You must articulate what you want to accomplish before you start," explains Tocco. This group also would select members of the full planning committee that would include all disciplines involved in the care and education of a patient for the target disease.

For example, if the disease management program is for diabetes, a dietitian or nutritionist may be included on the committee; for a depression program, a psychiatric nurse may be on the committee. The committee’s membership will differ with the disease.

Once the core team has established both the goals and objectives and the committee, the process of developing a program begins. Following are five steps Tocco suggests be included in the development of a successful disease management program.

Step One: Develop a registry of patients based on agreed-upon criteria. The purpose of the registry is to identify patients who are currently diagnosed or treated for a specific disease and to create a benchmark against which to evaluate the effectiveness of the program. This process also could be used to create a method to screen patients for a specific disease.

Step Two: Develop treatment algorithms or protocols. A protocol provides guidelines for the treatment of a patient with a particular disease. An algorithm offers various options at each step of the treatment process. "I see a protocol as a specific treatment process for a physician to follow, such as cookbook medicine, whereas an algorithm is more of a decision tree offering options that may be available to the physician. Hence the art of medicine is left to the physician," says Tocco.

Step Three: Develop provider and patient management tools. These tasks could be assigned to two separate subcommittees. The health care providers must learn how the complete program works. For example, providers need to understand how the patient registries work, how to use the algorithm, when to refer a patient to a specialist, and how to monitor the patient. The patient education committee would develop tools to educate the patients about how they can participate in their treatment.

Step Four: Develop a method to measure the effectiveness of the program. For example, a committee developing a depression management program might decide to monitor whether the screening and diagnosis methods suggested in the algorithm are uncovering more patients suffering from depression at an earlier stage of the condition.

Step Five: Develop a quality improvement plan that ensures the program keeps abreast of new treatments and medications.

[For more information on setting up a disease management program, contact Michael Tocco, RPh, MEd, President ICPR: Integrated CARE Group, 255 Bear Hill Road, Waltham, MA 02451-9392. Telephone: (781) 890-3434. Fax (781) 890-2766. E-mail: tocco@icpr.com.]