The value of disease management - Approaching the industrialisation of modern medicine

Recent years have seen the beginning of an industrial revolution in healthc are delivery. Healthcare is being transformed from a cottage industry, in w hich each provider sets individual standards, to a quality-controlled enter prise with common, evidence-based standards of care. Disease management is fundamental to this transformation; it is based on the application of the i ndustrial engineering principle of 'total quality management' to healthcare as 'continuous quality improvement'. As little evidence has been published in the peer-reviewed literature regar ding the cost effectiveness of disease management, specific disease managem ent programmes should be judged by the extent to which its design adheres t o the principles of continuous quality improvement. Disease: management sho uld, furthermore, be integrated into the overall activities of the healthca re system rather than being a carve-out offering. The true value of disease management is as a paradigm by which the healthca re system can re-engineer how it goes about its business - with clear goals , recognised standards and ongoing monitoring. The adoption of evidence-bas ed best practice guidelines and the attendant reduction in practice variati on will inevitably benefit millions of patients.