ISQUA18-2518Clinical, Social and Economic Results after the Implementation of a Disease Management Program for Rheumatoid Arthritis

Abstract

Objectives: Hospitals with specific management practices are strongly related to an institution's quality and outcomes of patient care, not to mention productivity and financial results. Furthermore disease management programs guaranty effective results which reduce adverse effects and variability when treating patients. This allows institutions to report results transparently and feed data bases that permit pharmaceutical and governmental agents to invest resources adequately. There is another benefit of disease management: patient centered care and empowerment. Patients can make their own decisions when it comes to choosing a treatment center and do so based on transparent and accountable results. This generates the need for hospitals to strive for the best results possible in order to compete in a new emerging market. This study seeks to demonstrate the clinical, social and economic results after the implementation of a disease management program for rheumatoid arthritis (RA), lead by a team of rheumatologists at a private, non-profit, hospital in Bogota, Colombia. Method(s): Starting in 2013 Fundacion Santa Fe de Bogota initiated a new management program for RA utilizing six distinct phases: Promotion, Access and Early Diagnosis, Diagnosis, Medical Attention, Support and Self-Care and Monitoring. Through the use of quantitative analysis three fields of indicators were established: clinical (referrals and early treatment), social (patient satisfaction) and economical (resource management) measurements. As previously mentioned, poorly treated and managed RA directly and indirectly affects these three domains. Each set of indicators was comprised out of a justification (supported by evidence based medicine), description and a measurable component. These monitored the structure, process and results of the program. In other words, the hospital determined if the established disease management proposal met criteria for safety and effectiveness whilst minimizing risks and variability through the use of these markers. Result(s): In regards to the clinical indicators the program showed a 92% increase in early referrals of RA. This has permitted early treatment and management of patients which is critical for better prognosis. Current program data shows that up to 72.26% of patients show improvements in their functionality. The patient centered model also increased satisfaction to 98% and lead to better feedback from users and their families. Finally, the program has demonstrated an optimization of the health system's resources due to standardization. Biological treatment formulation is of 7.6% compared to the national average of 36%. Conclusion(s): Disease management programs and institutional certification as centers of excellence through result transparency for the public is the key. Each phase of a disease management program requires the integration of different players, especially at the clinicalpatient relationship plane. Gaining patient trust and integrating a functional team that in some cases begins at an extra-institutional manner can be overwhelming. Even more challenging, not only must the team work together and be highly trained, the patient must as well. Patients must be educated in regards to their disease and on their importance for a successful outcome. If permanently successful, this program may take part in the big data revolution and in the new emerging market that is based on transparency as a form of institutional competition.