1. Disease Management & ADMA
Dr Marco Bonollo
A/Prof Lisa Demos
Ms Kaylene Fiddes

2. Disease Management in Australia
ADMA

3. Disease Management Activity
NSW: NSW Chronic Care Program
VIC: HARP Chronic Disease Management
& Early Intervention in Chronic Disease
WA:
NT: preventable chronic diseases strategy (pcds)
TAS: Chronic Conditions Prevention & Management
SA: Lifestyle risk program due soon

4. Disease Management Activity
Federal
Medicare item numbers
NHMRC
National Health and Hospitals Reform Commission TOR
NGO & Foundations - Flinders self-management/ Lorig self-management
Private health insurance
Online and telephone

5. Summary of chronic disease management approaches
Intensive care coordination
Home visits & telephone
GP, Specialist communication
Self management
Service coordination / referrals
Early warning signs
Brokerage
High Complex Case Management
GP, Specialist communication
Self management
Service coordination / referrals
Telephone monitoring
High/Moderate Risk Care Coordination
I would now like to talk about some of the Victorian initiatives aimed at improving chronic disease prevention and management
The care across the continuum in Victoria can be represented diagrammatically using a pyramid. Many of you will be familiar with the chronic disease pyramid.
The base of the pyramid - Level 4 – These approaches are aimed at the whole of the population approach, and focus on primary prevention and risk identification
Level 3 – relates to people who have a chronic disease but are not suffering hospitalisation due to their condition and who can, through a partnership approach learn to better manage their condition. These clients can be managed with the primary health care sector; including general practice and community health services.
Level 1 & 2 represents people who are frequent users of the hospital system or at risk of hospitalisation as a result of their disease. ttarget people with chronic disease or complex needs who regularly use hospital and is an intervention delivered through collaboration between hospitals and the community sector.
It is acknowledged that clients with chronic and complex care needs may move through the levels at various times across their lifespan and the service system is working to ensure seamless care provision is available.
Smoking, BP, obesity etc
Primary Prevention

6. Disease Management Models
May include one or several of the following components:
self-management – mailouts to 6 week programs
behaviour change
health risk assessments
telephone or online coaching
outreach visits
coordinated clinics
care coordination
HMRs
disease specific vs complex co-morbid patient programs

7. Disease Management Models
These occur in a range of settings
acute hospitals
general practice
community health
private health funds
call centres
workplaces and
home environments

8. Evaluation Several DM initiatives have demonstrated:
↓ ED Presentations
↓ Hospital admissions
↓ LOS and bed days
↓ costs
Peytremann-Btidevaux et al. Am J Med 2008
Adams et al. Arch Intern Med 2007
Martinez et al. Telemed Telecare 2006
Roccaforte et al. Eur J Heart Fail 2005
(DM Reviews)
Peytremann-Btidevaux et al. Effectiveness of chronic obstructive pulmonary disease management programs: systematic review and meta-anaylsis. Am J Med 2008; 121:433-43
Roccaforte et al. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur J Heart Fail 2005; 7:
Adams et al. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management. Arch Intern Med 2007; 167:551-61
Martinez et al. A Systematic review of the literature on home monitoring for patients with heart failure. J Telemed Telecare 2006; 12:234-41
DM Reviews

9. Evaluation Other DM initiatives have not demonstrated effectiveness
Medicaid trials did not meet agreed outcomes – some abandoned
BMJ review questioned effectiveness
Peytremann-Btidevaux et al. Effectiveness of chronic obstructive pulmonary disease management programs: systematic review and meta-anaylsis. Am J Med 2008; 121:433-43
Roccaforte et al. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur J Heart Fail 2005; 7:
Adams et al. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management. Arch Intern Med 2007; 167:551-61
Martinez et al. A Systematic review of the literature on home monitoring for patients with heart failure. J Telemed Telecare 2006; 12:234-41
DM Reviews

10. Australian Disease Management Association (ADMA)
Is a not-for-profit Association
Provides forums and advocacy for providers working in disease management
Provides educational forums to organisations, providers, funders and healthcare policy makers.
Promotes programs which
improve population health
improve chronic condition outcomes and quality of life and
reduce acute healthcare utilisation and costs.

11. ADMA National Annual Conference - 4th & 5th September 2008
Quarterly DM Review, Newsletters
Forums – workshop days, breakfasts, dinners
DM Line
Website
National and international links

12. Disease Management - Australia
Varying initiatives being implemented across Australia
No definition, standards/guidelines, KPIs

13. ADMA external consultation
External review currently underway
Guided by a small working group
Interview national key stakeholders - views on state of DM and future of DM
Current status, assessment of processes & operational components of DM, views on future demand, view on need for national approach, priorities for a national approach

14. Findings - DM White paper developed
To be presented at the ADMA conference
Will include views on status and future of DM, top priorities for DM etc
ADMA strategic direction