CBO: Jury still out on disease management
Insufficient evidence exists to prove that disease management programs can lower overall health care costs, concluded the Congressional Budget Office (CBO) in an Oct. 13, 2004, press release.
The CBO based its analysis, conducted at the request of Senate Budget Chairman Don Nickels (R-OK), on a review of medical journal studies on disease management programs for congestive heart failure, coronary artery disease, and diabetes.
The CBO found that few studies directly addressed the costs of such programs, and those that did failed to capture all forms of health care spending, excluded administrative costs, did not consider the unintended consequences of intervention and were conducted in limited, controlled settings.
If applied to a broader population, the programs actually could increase health costs, the report said.
The CBO also found little evidence to address obstacles in translating disease management into savings for Medicare, including an older, sicker population and the current fee-for-service system. But in a letter prefacing the report, CBO director Douglas Holtz-Eakin pointed out that "such programs could be worthwhile even if they did not reduce costs." He also said the CBO will continue new research as it becomes available.
Practice strategies don't affect diabetes care
A Harvard Medical School study has found that current practice management strategies and financial arrangements have a limited impact on the quality of care for patients with diabetes. Led by Nancy L. Keating, MD, researchers reviewed medical records of 652 diabetes patients enrolled in three health plans in Minnesota along with the 399 physicians in 135 practices who cared for them.
Researchers defined the main outcome measures by a quality score indicating receipt of care in accordance with six accepted quality indicators.
Only 5% of the variation in quality was attri-buted to characteristics of physicians' practices. Quality scores tended to be higher for patients whose physicians received quality performance reports or utilization profiles from more than one source, routinely enrolled diabetic patients in disease-management programs, or received diabetes-specific reports.
The study, The Influence of Physicians' Practice Management Strategies and Financial Arrangements on Quality of Care Among Patients With Diabetes, is available in the September issue of Medical Care, the journal of the American Public Health Association.
New fall prevention web resources available
The Safety Institute of Premier Inc. has launched a publicly accessible, web-based clearinghouse of resources and tools for fall prevention to define and measure falls, identify risks, and target prevention strategies among patients and residents. (Premier has offices in San Diego; Charlotte, NC; Oak Brook, IL; and Washington, DC.)
The Premier resources include:
- risk factor identification and evidence-based interventions;
- sample prevention programs with policies and procedures;
- tools for risk assessment, fall rate calculations, targeted interventions, and patient monitoring guidance;
- definitions, consensus standards, classifications from national organizations, and annotated references;
- national quality improvement and benchmarking initiatives;
- education and training programs, including presentation templates, case studies, fact sheets, and national guidelines;
- equipment or products designed to reduce risk of falls and/or back injuries.
The fall prevention module complements the Safety Institute's back injury prevention web module, a related issue for patient, resident, and worker safety. These web resources are part of the institute's web site on patient, worker, and environmental safety, which includes downloadable tools, resources, an on-line safety store, electronic newsletter, national safety conference proceedings, and more.
The information can be accessed free at: www.premierinc.com/safety. Click on "fall prevention module" or the worker safety icon for back injury and fall prevention resources.
WHO starts global patient safety group
The World Health Organization (WHO) has launched Partners in the World Alliance for Patient Safety, an international partnership aimed at improving patient safety globally.
The new partnership, which will include the U.S. Department of Health and Human Services (HHS), will focus its efforts over the next two years on reducing health care-associated infections; ensuring consistent concepts, principles, and terminology in patient safety work; conducting research; and generating and promoting best practice guidelines.
The alliance plans to build on existing efforts in individual countries in an effort to decrease adverse events worldwide.
"We have seen much progress in the last five years, but we have a long way to go to ensure that health care services provided around the world are as safe as they can be," said Carolyn Clancy, director of HHS' Agency for Healthcare Research and Quality, in announcing the partnership.
For more information, visit: www.who.int/mediacentre/news/releases/2004/pr74/en/.