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Medical history, your current and past these abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia because of the multifactorial nature.


Depression disease management program, cause of ringing sound in ears - For You

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Mustille and colleagues at Kaiser's Care Management Institute (CMI) in Oakland advocate aggressive treatment for people with chronic conditions. Kaiser has invested millions in the CMI programs, hoping to improve outcomes and thereby create savings through fewer hospitalizations and emergency department visits. Health plans seem most interested in CMI's concept of population management, says Mustille. PacifiCare Health Systems will launch a program in August under which any member will get a premium reduction if he or she earns a certain number of "health credits" by enrolling in an online health club, filling out a health risk assessment survey, and joining a weight-loss program.
Using this information, Kaiser divides members with 1 or more of 5 priority chronic conditions, including diabetes, asthma, congestive heart failure, coronary artery disease, and depression, into three risk levels. Kaiser's creation of a set of clinical care management programs has significantly reduced the rate of cost increase for the treatment of its patients with chronic conditions, although not overall costs, says Mustille. Some observers think that the move toward consumer-focused health care will encourage more aggressive treatment of chronic diseases. In any case, in order to do a better job of meeting the health care needs of the growing number of people with chronic and multiple chronic conditions, the current health care system needs to be reoriented from acute, episodic illness treatment to a system that provides continuity, ongoing management and coordination, say experts. But Kaiser's attempt to manage chronically ill patients has been the exception; most plans are only lately beginning to address chronic care management.

Their programs go beyond disease management, says Mustille, in that they are highly integrated into primary care protocols. CMI's chronic care management initiative is founded on data registries that define and track disease populations. They are referred to disease-specific management programs that combine efforts of the primary care team with those of additional care-givers such as behavioral health clinicians, respiratory therapists, physical therapists, and specialist physicians and nurses in disease-specific clinics.
Care management for these patients is coordinated by case managers, usually registered nurses or medical social workers. It will soon begin a program in which doctors will record patients' body mass index at annual physicals. All age groups reported that government programs were inadequate to meet the needs of such patients, and that health insurance fails to pay for most of the services required. In 1999, Kaiser Permanente launched care management programs through CMI that target diabetes, coronary artery disease, hyperlipidemia, asthma, and congestive heart failure. The registries produce paper and online reports, which in turn are used to create care management tools and provide feedback to physicians about their patients.
The most common chronic condition in adults is hypertension (26 percent of non-institutionalized people with chronic diseases), chronic mental conditions (22 percent), respiratory disease (18 percent), arthritis (13 percent), heart disease (12 percent), eye disorders (10 percent ), asthma (10 percent), cholesterol disorders (9 percent), and diabetes (9 percent), and many people have more than one of these conditions.

Oxford has a program that targets people with diabetes and congestive heart failure who have not visited a specialist in over a year and helps them make an appointment. And for diabetics with depression, that figure doubles to 2,000 hospital days per 1,000 members per year. In children the most common chronic conditions are respiratory diseases (33 percent) and asthma (28 percent). Anderson, MD, national program director for Partnership for Solutions, finds encouraging because it suggest that "policymakers are starting to get the message that health care for chronic diseases in the U.S. Since Kaiser began its chronic care management program, that figure has remained stable when the average cost of treating patients has risen significantly, he says.

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