November 26, 1997

Evidence-Based Disease Management

Author Affiliations

From the Division of General Internal Medicine (Dr Ellrodt) and the Health Services Research Fellowship Program (Dr Lee), Department of Medicine, and the Departments of Pharmacy (Dr Cho), Health Services Research, Department of Medicine (Dr Weingarten), Cedars-Sinai Medical Center, University of Cailfornia, Los Angeles, UCLA School of Medicine; and the Department of Medicine, Division of General Internal Medicine (Drs Cook and Hunt), and Department of Clinical Epidemiology and Biostatistics (Dr Cook), McMaster University Faculty of Health Sciences, Hamilton, Ontario.
Dr Ellrodt now works for CSC/APM assisting health care providers in building disease management programs. In addition to his position at Cedars-Sinai Health System, Dr Weingarten works for a wholly owned subsidiary of Cedars-Sinai Health System that markets clinical decision support software and consulting services.

JAMA. 1997;278(20):1687-1692. doi:10.1001/jama.1997.03550200063033

Disease management is an approach to patient care that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems. Evidence-based medicine is an approach to practice and teaching that integrates pathophysiological rationale, caregiver experience, and patient preferences with valid and current clinical research evidence. Using diabetes mellitus as an example, we describe the importance of evidence-based medicine to the development of disease management programs. We present a method for developing and implementing evidence-based clinical guidelines, clinical pathways, and algorithms and describe the creation of systems to measure and report processes and outcomes that could drive quality improvement in diabetes care. Multidisciplinary teams are ideally suited to develop, lead, and implement evidence-based disease management programs, since they play an essential role in the preventive, diagnostic, and therapeutic decisions for patients with diabetes throughout the course of their disease.