Disease Management Programs for the Underserved

Abstract

Disease management has become an important tool for improving population patient outcomes. The Louisiana State University Health Care Services Division (HCSD) has used this tool to provide care to a largely uninsured population for approximately 10 years. Eight programs currently exist within the HCSD focusing on diabetes, asthma, congestive heart failure, HIV, cancer screening, smoking cessation, chronic kidney disease, and diet, exercise, and weight control. These programs operate at hospital and clinic sites located in 8 population centers throughout southern Louisiana. The programs are structured to be managed at the system level with a clinical expert for each area guiding the scope of the program and defining new goals. Care largely adheres to evidence-based guidelines set forth by professional organizations. To monitor quality of care, indicators are defined within each area and benchmarked to achieve the most effective measures in our population. For example, hemoglobin A1c levels have shown improvements with nearly 54% of the population <7.0%. To support these management efforts, HCSD utilizes an electronic data repository that allows physicians to track patient labs and other tests as well as reminders. To ensure appropriate treatment, patients are able to enroll in the Medication Assistance program. This largely improves adherence to medications for those patients unable to afford them otherwise.

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

“…81,83 Seven studies reported statistically significant increase in the provision of patient education/asthma action plans of 14% to 84% (all reported as statistically significant). 19,36,38,81,[83][84][85] Three of the 4 RCTs reported no significant difference. 45,47,82 SOE: moderate.…”

“…37,96 Several studies included children. 5,37,46,85,96 Nine studies reported a reduction in ED visits or hospitalizations 5,[36][37][38]46,84,85,95,96 (5%-60%) among pre-post studies (all statistically significant) and 1% to 7% among the RCTs. 5,37,95 SOE: moderate.…”

“…Fifteen studies were identified that included the provision of asthma guidelines in a more accessible format (eg, "pocket" versions), [36][37][38] use of a specific algorithm, pathway, or flow sheet, 37 …”

“…We identified 10 studies 19,36,38,45,47,[81][82][83][84][85] that included computerized support, 36,45,47,82,84 a flow sheet/algorithm, 19,85 and/or the provision of guidelines. 38 Two of the 3 studies focused on pediatricians.…”

Awareness and Implementation of the 2000 United States Public Health Service Tobacco Dependence Treatment Guideline in a Public Hospital System

“…TCI management team worked with the LSU system information technology group to design tobaccospecific items for inclusion in its evolving Clinical Inquiry (CliQ) system. 15 It is expected that the number of staff and the time required to document the use of the 5 A's approach will be substantially reduced as CliQ use expands.…”