[The future is chronic].
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Education, Medical, Continuing↗
Biomedical subjects
Ed Wagner
Publications and source records attributed to Ed Wagner.
[The future is chronic: German primary care and the Chronic Care Model--The comprehensive principles in the proactive treatment of the chronically ill].
BACKGROUND: In Germany, primary healthcare for patients with chronic diseases needs to be improved. Taking the example of depression, congestive heart failure, diabetes and diseases of the musculoskeletal system we analyzed to which extent the 'Chronic Care Model' allows for improvements. METHODS: Diagnosis-specific health assessment; adaptation of the 'Chronic Care Model' to the German healthcare system; peer reviewed discussions of the potentials for improving primary care of the chronically ill. RESULTS/DISCUSSION OF THE HEALTHCARE SITUATION: 1) Diagnosis and therapy of chronic diseases comply insufficiently with the evidence. 2) Patients are too passive and/or receive only little effective support. 3) Treatments are often uncoordinated and fragmented. 4) The follow-up of treatment results is often neglected. 5) Approaches to indicated diseases are promising. CONCLUSIONS: The'Chronic Care Model' could improve chronic care in Germany. Disease Management Programs (DMP) should amend multimorbidity and individual healthcare and/or facilitate implementation in general practice.
Chronic Disease↗
A multisite randomized trial of the effects of physician education and organizational change in chronic asthma care: cost-effectiveness analysis of the Pediatric Asthma Care Patient Outcomes Research Team II (PAC-PORT II).
BACKGROUND: A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact. The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies: a peer leader-based physician behavior change intervention (PLE) and a practice-based redesign called the planned asthma care intervention (PACI). OBJECTIVE: To estimate the cost-effectiveness of the interventions. METHODS: This was a 3-arm, cluster randomized trial conducted in 42 primary care practices. A total of 638 children (age range, 3-17 years) with mild to moderate persistent asthma were followed up for 2 years. Practices were randomized to PLE (n = 226), PACI (n = 213), or usual care (n = 199). The primary outcome was symptom-free days (SFDs). Costs included asthma-related health care utilization and intervention costs. RESULTS: Annual costs per patient were as follows: PACI, USD 1292; PLE, USD 504; and usual care, USD 385. The difference in annual SFDs was 6.5 days (95% confidence interval [CI], -3.6 to 16.9 days) for PLE vs usual care and 13.3 days (95% CI, 2.1-24.7 days) for PACI vs usual care. Compared with usual care, the incremental cost-effectiveness ratio was USD 18 per SFD gained for PLE (95% CI, USD 5.21-dominated) and USD 68 per SFD gained for PACI (95% CI, USD 37.36-361.16). CONCLUSIONS: Results of this study show that it is possible to increase SFDs in children and move organizations toward guideline recommendations on asthma control in settings where most children are receiving controller medications at baseline. However, the improvements were realized with an increase in the costs associated with asthma care.
Adolescent↗