Managed Care Systems and Emerging Infections Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary (2000) / Chapter Skim
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4 Surveillance and Monitoring
4 Surveillance and Monitoring
Pages 33-51
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From page 33... ...
Yet, each aspect of infectious disease surveillance is evolving independently and rapidly. Cost-reduction and reimbursement efforts through managed care emphasize the heavy reliance on empiric care rather than laboratory data.
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From page 34... ...
The uniqueness of each managed care organization and the essential capabilities of private and public microbiological laboratories underscore the importance of working together. The challenge that lies ahead is how to plan a comprehensive infectious disease surveillance system that allows maximum coordination and flexibility for change.
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From page 35... ...
MANAGED CARE AND INFECTIOUS DISEASE SURVEILLANCE: OPPORTUNITIES FOR COLLABORATION Presented by Denise Koo, M.D., M.P.H. Director, Division of Public Health Surveillance and Informatics, Centers for Disease Control and Prevention Public health surveillance and monitoring activities are a cornerstone of public health practice, providing information essential for assessing public health status, monitoring trends, suggesting public health priorities, and evaluating the effectiveness of public health programs.
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From page 36... ...
In general, managed care systems provide an excellent opportunity for public health agencies to clarify their role in infectious disease surveillance and response and to build partnerships to ensure communication concerning cases of disease and opportunities for prevention of the spread of disease. Public health officials need to disseminate infectious disease surveillance data and reports to health care providers in a timely, readily accessible, and useful manner.
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From page 37... ...
Some pilot studies conducted by managed care organizations and public health agencies are trying to determine the quality, accuracy, and availability of data regarding infectious diseases. These studies are showing that diagnostic testing may actually be no less prevalent among providers associated with managed care organizations than among other providers.
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From page 38... ...
. Recently, Harvard Pilgrim Health Care used the information from its staff model program to study surgical site infections (SSIs)
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From page 39... ...
On He basis ofthese findings and under a cooperative agreement with CDC's Hospital Infections Program, Harvard Pilgrim Health Care is collaborating with 11 hospitals and the Free largest HMOs in eastern Massachusetts to assess the broader applicability of these methods. All of these participants realize the need to serve the public's health.
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From page 40... ...
Future activities under this agreement may include monitoring of other nosocomial infections, including neonatal infections and implanted central venous catheter infections. Ultimately, these and similar collaborative efforts should serve as models for surveillance systems that work best when public health agencies and all of the participants involved in the care of individuals work together.
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From page 41... ...
It also suggests medications for specific patients on the basis of prescription guidelines and current indicators such as white cell count, fever, and results of microbiological cultures and roentgenograms. In He case of emerging infections, the system also alerts the physician to infections caused by multiple-drug-resistant organisms or to a prescription that is at odds with what would normally be prescribed.
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From page 42... ...
Surveillance and monitoring will fail if that threshold is not met. The efficiency of infectious disease surveillance will likely be affected by the dramatic changes that are occurring in the U.S.
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From page 43... ...
Moreover, the National Committee for Quality Assurance (NCQA) is placing a greater emphasis on outcomes in making accreditation decisions about managed care organizations and will likely begin to accredit provider organizations.
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From page 44... ...
Only 43 percent of public health laboratory directors agreed with this widely held opinion, whereas 47 percent thought that managed care has no impact on public health efforts and 10 percent pointed to positive effects from managed care. Under managed care, however, there is a tendency to treat patients empirically on the basis of symptoms rather than to perform laboratory tests and use the results of those tests as a basis for specific diagnoses.
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From page 45... ...
Ideally, surveillance should be a coordinated process in which the health department sets the agenda for surveillance, epidemiological, and statistical studies; contracts with a managed care plan to provide the information; uses the findings to assess health risks; and allocates resources to those events that pose the greatest risks. Contracting with managed care organizations to identify clusters of diseases in the enrolled population is a desirable strategy.
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From page 46... ...
The lack of understanding of the health department's role in surveillance may have originated either from the absence of feedback from public health agencies indicating how data are used or from a lack of availability of the data to the public, providers, or potential users of those data. Workshop participants asserted that managed care systems must provide an opportunity for public health agencies not only to explain their roles in surveillance and response but also to establish partnerships as a way of ensuring bilateral communication on cases of infectious diseases and opportunities for preventing the spread of infectious diseases.
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From page 47... ...
Managed care organizations also have the opportunity to establish partnerships with public health agencies to prevent the spread of infectious diseases. Ensuring Availability of Data The possibility that fewer diagnostic tests will be performed in managed care systems as a result of cost-reduction requirements could lead to a decrease in the amount of information on emerging infectious diseases needed by public health officials.
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From page 48... ...
To avoid duplication of effort and maximize efficiency, a workshop speaker proposed that public health agencies need to work with managed care organizations to ensure that direct reporting is conducted from their laboratory data systems to public health agencies for surveillance purposes. Tracking Nosocomial Infections The increasing use of ambulatory-care settings for surgical operations and postoperative care may hinder the ability to adequately track and monitor nosocomial infections because of the decreased disease reporting capabilities of such settings.
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From page 49... ...
Accurate Reporting of Encounter-Level Data Effective surveillance for emerging infections and varying infection trends requires reporting of an accurate diagnosis in a standardized manner and requires that the trends be monitored on a continuous basis. Although fairly common infections require only that a small but consistent portion of cases be recognized and reported for effective surveillance, conditions that occur infrequently require highly efficient capture of a diagnosis so that changes in their patterns can be recognized.
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From page 50... ...
Such communication could help dissolve the structural barriers between surveillance and practice in managed care organizations and subsequently facilitate the exchange of information. Additionally, the large national laboratories that are used extensively by managed care systems need to implement better internal guidance policies to help identify which states require the reporting of which infectious diseases.
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From page 51... ...
Finally, when states seek to contract out services for their Medicaid populations, such contracts must incorporate terminology that will take into account the need for surveillance and monitoring as well as emerging infection issues. Summary There is concern that managed care may have a negative effect on infectious disease surveillance and monitoring.
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