Social Workers' Role in Disease Management
Claiborne, Nancy, Vandenburgh, Henry, Health and Social Work
This article discusses social work's participation in a new paradigm for health care delivery disease management. Attempts to improve health care quality have focused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the need for social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocial factors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.
Health care experts and managed care organizations have heralded disease management as the delivery of care system currently most likely to integrate quality-of-care issues and cost efficiencies (Rauber, 1999). The disease management model is a coordinated, proactive approach that maximizes the effectiveness of patient care for specific chronic diseases over time. This client-centered approach views patients as individuals experiencing the course of a disease, rather than seeing care as a series of discrete treatment episodes. It endeavors to coordinate resources across the health care delivery system, rather than provide separate services within a fragmented health care system (Ellrodt et al., 1997). The model centrally locates a case manager (in a primary care group practice office or managed care organization) who then frequently communicates with the patient and acts as the primary coordinator of care across multiple inpatient, outpatient, and community-based entities. The location of the patient is irrel evant because the disease management case manager provides seamless care coordination regardless of service location. The primary care physician, the patient, and an interdisciplinary team apply standards of care to meet certain prescribed objectives (Katon et al., 1997). These standards, or evidence-based practice guidelines, are derived from rigorous research. They inform the team of the preventive and acute interventions proven to provide effective medical outcomes and improve health-related quality of life. Disease management models require data collection and outcomes tracking because patient feedback and objective medical data are used to ascertain what does and does not work. Quantitative outcome instruments measure individual patient changes over time. The patient's treatment and progress also can be compared with national data on best practices and expected outcomes. Continuous quality improvement is central to disease management. The team can track the disease process over time, using all available feedback, to optimize patient recovery and prevent recurrence (Hunter & Fairfield, 1997).
Interest in disease management programs has grown since 1997 as large integrated delivery systems and managed care companies announced improvements in medical outcomes and substantial cost reductions. Their efforts have focused on controlling chronic conditions and preventing related complications. For diabetes, Kaiser Permenente announced a 15 percent improvement in glycemic levels for 250,000 individuals enrolled in a 1997 disease management program (Rauber, 1999). In 1998 Humana announced a savings of $22 million through disease management programs. It reported a 15 percent improvement in functional status, a 60 percent decrease in hospitalizations, and an initial 78 percent reduction in inpatient costs for individuals enrolled in their congestive heart failure disease management program (PR Newswire Association, 1998). Revenues realized by companies and consultants specializing in disease management programs grew from $80 million in 1997 to $180 million in 1998. …