Disease Management: An Intermediate Step Toward Integrated and Coordinated Patient Care

Abstract

The purpose of this article is to examine the evolving role of disease management in healthcare delivery and how it is adapting to meet the needs of patients in the current environment. An alternative view of disease management is contrasted to the more traditional one currently held by most in the field. Disease management is pragmatically conceived as the manageable subdomains of a quality improvement process applied to healthcare. This conception reflects the wholly inadequate information and decision support systems currently employed in healthcare. The transition from a pragmatic to a more comprehensive and integrated disease and health management approach will accompany advances in the development and adoption of medical informatics, including electronic medical records (EMRs) and handheld clinical support tools (e.g., personal digital assistants [PDAs]). As such, pragmatic disease management is an artificial construct or a halfway technology that one can expect will be replaced as real-time measurement and management of process and outcomes becomes embedded into the fabric of healthcare delivery. Given this scenario, efforts to codify or standardize disease management might not be prudent, as it would inhibit innovation. Indeed, the value of disease management will be determined in the marketplace based on its ability to enhance the effectiveness and efficiency of healthcare delivery, not by its conformance to well intentioned but fixed definitions of appropriate processes of care.