Health technologies for the improvement of chronic disease management: a review of the Medical Advisory Secretariat evidence-based analyses between 2006 and 2011.
BACKGROUND
As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]).


OBJECTIVE
The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community.


METHODS
The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011.


METHODS
Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures.


RESULTS
Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease.


CONCLUSIONS
The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient outcomes; reduce resource utilization intensity; be cost-effective; and be a viable contributing factor to chronic disease management in the community.


CONCLUSIONS
People with chronic diseases rely on the health care system to help manage their illness. Hospital use can be costly, so community-based alternatives are often preferred. Research published in the Ontario Health Technology Assessment Series between 2006 and 2011 was reviewed to identify health technologies that have been effective or cost-effective in helping to manage chronic disease in the community. All technologies identified led to better patient outcomes and less use of health services. Most were also cost-effective. Two technologies that can cure chronic disease and 1 that can prevent chronic disease were found. Eight technologies that can help manage chronic disease were also found. Health technologies should be considered an important part of chronic disease management in the community.
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Nikitovic
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Brener
D055011:Ablation Techniques / Q000191:economics; D050110:Bariatric Surgery / Q000191:economics; D020811:Biomedical Technology / Q000191:economics*; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003153:Community Health Services; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000601:surgery; D019468:Disease Management; D019317:Evidence-Based Medicine; D006077:Government Agencies; D006302:Health Services Research; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000191:economics; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D058996:Quality Improvement; D011788:Quality of Life; D016540:Smoking Cessation / Q000191:economics; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D015912:Thrombolytic Therapy / Q000191:economics; D014611:Vaccination / Q000191:economics