Disease Management: What Does the Research Evidence Show?

David B. Nash, MD, MBA, FACP

In This Article

Abstract and Introduction

Chronic illnesses affect more than 100 million Americans and account for 75% of the nation's annual health care costs. There has been little emphasis by traditional health care delivery systems in preventing chronic disease and/or delaying the onset and severity of their complications. The evolution of disease management (DM) as a patient-centered and cost-effective approach to managing chronic illness is discussed. The article reviews the research evidence and concludes that DM can improve the quality of health care significantly. However, improved quality does not always translate into immediate reductions in direct health care costs. The application of DM is moving from case management to health management for at-risk populations. The greatest promise for the DM approach to chronic illness lies in delivering effective interventions as early as possible in the course of the disease.

Faced with a second straight year of double-digit increases in health care premiums, employers have renewed their efforts to find strategies for damping down rising health care costs. The Washington Business Group on Health, for instance, created the Institute on Health Care Costs and Solutions and asked the Office of Health Policy and Clinical Outcomes at Jefferson Medical College to conduct an in-depth study of the scientific evidence for disease management (DM). We were also asked to provide criteria that employers and other stakeholders could use to evaluate which programs they might want to buy or "rent."

The resulting "Disease Management Issue Brief," published this past summer, represents a comprehensive review of the literature going back 40 years and provides a distillation of the published evidence, looking at programs in diabetes, congestive heart failure (CHF), asthma, and other chronic diseases.[1] This article summarizes much of that report and adds some personal observations.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.