.......For our disease management program to be successful, we must begin with knowledgeable providers. To ensure providers have an adequate knowledge base, we should begin with academic detailing. "Academic detailing" occurs when the provider learns about the best practices for the disease of interest from a recognized expert in the field. This can and should be done through a variety of settings --- general staff and departmental meetings, grand rounds, video conferences, etc.

.......Beyond the didactic sessions, information should be available to the providers at the points of care in either a low-tech (laminated practice guidelines) or high-tech (computerized interactive programs) format. This would assure that the clinical decision support information would be conveniently available for the providers.

.......We also have to support the physician's work. The disease management structure must not be seen as another layer of paperwork that does not support or facilitate the physician's job. The support initially required is to identify for the physician those patients who meet the eligibility for the disease management program and get them enrolled. The physician should also get information about the essential elements of the patient’s participation in disease management. The physician should get reminder alerts when a needed patient activity has not occurred. Providers should be alerted whenever the defined values for a patient's treatment plan do not meet the appropriate standard or target.

.......This requires feedback about individual patients on a regular basis as well as summary measures of how is particular population of patients is doing relative to the best practice guidelines, and how a particular provider is performing compared to his peers and the evidence-based standards.








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