title: A combined disease management and process modeling approach for assessing and improving care processes: a fall management case-study.
abstract: OBJECTIVE
  To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study.
  
  
  METHODS
  We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees.
  
  
  RESULTS
  The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid.
  
  
  CONCLUSIONS
  The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.askari@amc.uva.nl.
authors.forename: Marjan
authors.initials: M
authors.lastname: Askari
authors.affiliation: Dutch College of General Practitioners, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Westerhof
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Saied
authors.initials: S
authors.lastname: Eslami
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Medlock
authors.affiliation: Department of Internal and Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D019090:Case Management / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D017598:Efficiency, Organizational; D017146:Models, Organizational; D009426:Netherlands; D017064:Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*
keywords: Disease management; Healthcare process assessment; Process modeling; Quality of care evaluation