Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.
BACKGROUND
Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations.


OBJECTIVE
To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM.


METHODS
Qualitative survey.


METHODS
Forty-seven healthcare systems (n = 22) and managed care organizations (n = 25) were randomly selected. Decision makers were identified and interviewed between January 1, 2000, and March 31, 2000. We limited quantitative analysis to tabulations of suitable responses, without statistical testing. Responses were organized around 3 themes: models for DM, implementation strategies, and measurements of success.


RESULTS
Of 47 decision makers surveyed, 42 (89%) reported that their organizations currently have (75%) or are working to develop (14%) DM programs. Although the goals of DM programs were similar, organizations took a variety of approaches to achieving these ends. There were typically 3 steps in implementing a DM program: analysis of patient data, external analysis, and organizational analysis. Decision makers believed that DM programs had only achieved partial success in reaching the 2 main goals of improved quality of care and cost savings.


CONCLUSIONS
Given the variety of DM programs, there is a need to develop a classification scheme to allow for better comparison between programs. Further quantitative studies of decision makers' opinions would be helpful in developing programs and in designing necessary studies of patient management strategies.
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. whell001@mc.duke.edu
David J
DJ
Whellan
Elizabeth J
EJ
Cohen
David B
DB
Matchar
Robert M
RM
Califf
D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D004059:Diffusion of Innovation; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D014481:United States