Disease Management Interventions: What's in the Black Box?

Abstract

In discussing evaluation techniques to assess disease management (DM) program outcomes, it is often assumed that DM program interventions are premised on sound clinical judgment, an understanding of the disease process, and knowledge of the psychosocial models of behavioral change that must be used to effect those processes and ultimately improve the health outcomes that are being evaluated. This paper describes eight commonly used behavioral change models applied in the healthcare industry today. They represent programs designed to address individual, interpersonal, and community level factors as well as "packaged" comprehensive approaches. These models illustrate the breadth of approaches to consider when designing or assessing DM program interventions. Careful consideration of the type of behavioral change desired and the theories of how to effect such change should be an integral part of designing disease management program interventions.

The Use and Influence of Employee Incentives on Participation and Throughput in a Telephonic Disease Management Program

“…Much of this variability may be traced to programmatic differences in the targeted population, diseases covered, intervention strategies used to induce behavior change, means of identifying participants, intervention pathways, intensity of interaction with provider(s), outcome evaluation criteria, and degree of administrative control over program implementation. 4,5 Successful DM interventions are tailored to the unique needs and circumstances of a client's population. Understanding what motivates employees to participate in programs that will give them greater control over their health is receiving increased attention at a time when employers are attempting to hold down rising medical costs.…”

Diabetes Education and Serious Gaming: Teaching Adolescents to Cope with Diabetes

“…Behavioral Change Models Disease management programs were developed under the assumption that health services utilization and morbidity could be reduced for those with chronic illness by augmenting the traditional episodic medical care system with services and support between doctors' visits (Linden & Roberts, 2004). For many chronic diseases, much opportunity exists to improve the quality and consistency of care, such as regular tests of glucose control (HbAlc).…”

“…Some of the behavioral models target all of the levels that are categorized under comprehensive models (Linden & Roberts, 2004). Figure 5.1 depicts the behavioral models used in different levels.…”

A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

“…Grol, Wensing, and Eccles recognize the marketing approach as one of several (e.g., educational, external influence, and social interaction approaches) used to implement clinical interventions [28]. Linden and Roberts note that social marketing is a comprehensive model--operating at the community, interpersonal, and individual levels--that shares goals and techniques with other healthcare behavioral change models [29]. The social marketing approach also is consistent with the empirically-based conceptual model for diffusion and dissemination of innovations in health services organizations recently proposed by Greenhalgh and colleagues [30].…”