Care Continuum Alliance (CCA) Definition of Disease Management
Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.
Disease management components include: *
* Note: Full-service disease management programs must include all six components. Programs consisting of fewer components are disease management support services.
Notes from the CCA Dictionary of Disease Management Terminology
Traditionally, disease management has focused on the "big five" chronic diseases: ischemic heart disease, diabetes, COPD, asthma and heart failure. Disease management programs generally are offered telephonically, involving interaction with a trained nursing professional, and require an extended series of interactions, including a strong educational element. Patients are expected to play an active role in managing their diseases.
Because of the presence of co-morbidities or multiple conditions in most high-risk patients, this approach may become operationally difficult to execute, with patients being cared for by more than one program. Over time, the industry has moved more toward a whole person model in which all the diseases a patient has are managed by a single disease management program.