The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

Disease Management Program Developed by Respiratory Therapists

Timothy R. Myers BS, RRT

In 1990, chronic disease conditions accounted for $425 billion of medical care costs. These chronic conditions account for 96% of home care visits, 80% of hospital days, 69% of hospital admissions, 66% of doctor and 55% of emergency room visits, and 55% of pharmacy prescriptions.^{1} Hence; the concept of disease management was created to combat these spiraling health care costs. Disease management is considered to be 'an approach to patient care that emphasizes coordination, comprehensive care along the continuum of disease and across health care delivery systems'.^{2}

Although disease management is an increasingly prevalent health care buzzword, the process is still a relatively new concept originating out of the Boston Consulting Group in 1993.^{3} The concept of disease management being centered around outcomes is still in its infancy. This serves to create an excellent opportunity for respiratory therapists to get involved in outcomes-focused, disease management in a variety of inpatient and outpatient settings.

Successful disease management programs must include a balance of evidence-based medicine, outcomes management, outcomes research, and continuous quality improvement to achieve the desired patient, clinical, and financial outcomes that are needed in today's health care environment. Benchmarking and outcomes research help provide a better understanding of what works, and what does not work. These concepts combined with a disease management program will develop a process for systematically evaluating benefits, risks and costs of various medical practices such as tests and therapies, and utilizing these results to define effective treatment strategies. Pulmonary diseases with clinical practice guidelines (or therapist driven protocols) create an ideal evidence-based format for outcomes management.

Disease management programs that utilize an outcomes management model strategy, stand the best chance for overall success measured through continuous quality improvement. This strategy will allow an organization or program to (1) develop goals, (2) review and standardize a practice, (3) implement "new" practice standards, and (4) analyze the "new" practice's outcomes data to improve the overall practice (or program). Recently published outcome studies on asthma interventions have documented isolated areas of effective disease management.^{4-7}

Respiratory care practitioners can add immense value to their organization by facilitating the development and initiation of an outcomes-driven, research-based, disease management program. Many respiratory related diseases (asthma, cystic fibrosis, COPD, etc.) are easily adapted to a disease management model. With a strong clinical and research-based background, respiratory therapists are well suited to facilitate or orchestrate outcomes-focused disease management programs for diseases like asthma and COPD. The perspective of this lecture is to highlight a disease management program for pediatric asthma that has used this evidence-based, outcomes-focused, model to develop a clinically and financially successful program.

1. Hoffman C, Rice D, Sung H-Y. Persons with chronic conditions. JAMA. 1996;276:1473-1479.

2. Ellrodt G, Cook D, Lee J et al. Evidence-Based Disease Management. JAMA. 1997;278:1687-1692.

3. Patterson R. Disease Management. Case Review. Fall 1995. 59-62.

4. Myers TR, Chatburn RL, and Kercsmar CM. A pediatric asthma unit staffed by respiratory therapists demonstrates positive clinical and financial outcomes. Resp Care. 1998;43(1):22-29.

5. McFadden ER, Elsanadi N, Dixon L, et al. Protocol therapy for acute asthma: therapeutic benefits and cost savings. Am J Med, 1995; 99: 651-60.

6. Volsko TA. A pediatric asthma clinic pilot program reduces emergency department visits, hospitalizations, and cost of care. Resp Care. 1998;43(2):107-113.

7. McDowell KM, Chatburn RL, Myers TR et al. A Cost Effective Algorithm for Children Hospitalized for Status Asthmaticus. Arch Pediatr Adolesc Med. 1998; October (in press).

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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