CURRENT ISSUES
OM programmes: lack of evaluation akin to medical negligence The lack of evaluation of disease management (DM) programmes by healthcare providers and payers should be considered a form of medical negligence, claims Neil MacKinnon from the University of Florida College of Pharmacy, US. He believes that such a claim should be a 'call to action' for these healthcare players to begin evaluating their DM programmes; otherwise DM programmes are unlikely to progress 'beyond a trendy fad' . He proposes a 7 -step approach to the formal evaluation of DM programmes that, although time- and resource-intensive, is critical to assessing the effectiveness of such programmes. The 7 steps are outlined below. 1. Adopt a systems approach. This requires consideration of all the resources, costs and key factors relating to the specified disease within the entire healthcare system. 2. Establish a framework for evaluation. The purpose and design of the DM programme must be identified at a very early stage as they are critical methodological issues in the evaluation of a DM programme. Furthermore, the goals and objectives of all programme partners must be clearly outlined in the DM contract.
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identify high-risk patients, and results are analysed. 6. Comparing criteria, standards, and goals. Data generated from the DM programme need to be compared to internal and external criteria, standards and goals. Benchmarking against other DM programmes is an important part of this step. 7. Formal evaluation. The information gained in the previous step .. needs to he written up to make sure that formal evaluation of the DM programme is not overlooked. Formal evaluation can help simplify the process of recontracting for new DM services and enhance the focus of the programme towards continuous quality improvement. MacKinnon NJ. A systems approach to the evaluation of a disease management programme. Formulary 33: 769· 770 & 775·778 & 787·788. Aug 1998 80070<'09
3. Identify key structures, processes and outcomes.
The quality of healthcare stems from the structures and processes that are in place, as well as the clinical, humanistic and economic outcomes that result. Many DM programmes fail to consider all 3 types of outcomes measures. 4. Develop specific performance measures. Performance measures are needed to adequately evaluate the key structures, processes and all 3 types of outcomes associated with DM programmes. Failure to include performance measures for all phases of the DM programme is a common pitfall. Performance measures need to be reliable, valid, feasible, and the data required for performance measures need to be easily 5. Collect, process, model and analyse data. Data collection is problematic, but essential, for evaluating DM programmes. Data collection is more likely to be successful for a disease that is of considerable interest to physicians and for which there are already channels for reporting data. There is also a need to construct a central database of information for the DM programme, to eliminate incorrect data, and to link all data sources via a unique patient identifier. Data are modelled to
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PhannacoEconomicS & Outcomes News 3 Oct 1998 No. 182
