*Four members of the National Managed Health Care Congress (NMHCC) Disease Management Outcomes Workgroup debated the pros and cons of six different issues before a group of knowledgeable listeners, and discovered that even in a short period, opinions could change significantly. Six issue statements were presented to the participants who were asked to respond to the statements with "agree, somewhat agree, neutral, somewhat disagree, and disagree" using wireless keypads. (The issue statements are below the graph.)
After the tally for one issue was displayed, one panelist spoke three minutes in favor of the statement. A second panelist spoke for three minutes against the statement. Then the poll was repeated. Dramatic shifts were evident in the responses to half of the statements. This indicates that discussion and debate is a valuable tool for the DM industry.
Jeff Gruen, MD, MBA, had assembled the DM Outcomes Workgroup for an earlier NMHCC conference to help attendees improve their comprehension of the complex financial and methodological elements of impact assessment in DM programs.
The workgroup has now presented successfully seven times at National Managed Health Care Congress/Disease Management trade shows, has produced a publication based on these results (Joint Commission Journal on Quality and Safety. November 2004, Volume 30, Number 11, Page 616. "Assessing Return on Investment of Defined-Population Disease Management Interventions." Authors: Thomas W. Wilson; Jeff Gruen; William Thar; Donald Fetterolf; Minalkumar Patel; Richard G. Popiel; Al Lewis; David B. Nash), and continues its work.
At the September 2005 Disease Management Congress in Orlando, Fla., the workgroup conducted a session titled "Who Wants to Avoid the Millionth Error? DM Reality Show Explores Issues Driving the Outcomes Measurement Debate."
Before each debate began, the question was read to audience members who were given the choice of five answers. The audience had about 30 seconds to respond, and the sums were displayed immediately.
One panelist defended the statement for three minutes (the pro position), followed by a three-minute speech from one panelist who argued against the issue (the con position). The poll was repeated for each issue, with the post-debate sums and pre-debate sums displayed.
Responses of "agree" and "somewhat agree" were combined into one category and "somewhat disagree" and "disagree" into another. Statistical significance tests were performed after the debate.
On 5 of the 6 issues debated, the percent that strongly agreed or agreed dropped as a result of the debate. Half of the time, the percent who strongly agreed or agreed showed a statistically significant difference after the discussion.
The three issues that show the most changes in participants' opinions were, in descending order of change: 1) uniform ROI measurement standard needed (number 1 in chart below); 2) controls regression-to-the-mean (number 4); and 3) DM dies in 3–5 years if federal projects fail to find value (number 6).
General conclusions from those polled, to the degree that they represented their respective institutions and the industry, would include the following:
We believe that the audience informed us that the industry must move toward more standardized methodologies that can more adequately adjust for regression to the mean and nonequivalence between the DM intervention population and the reference (e.g. trend, pre-period, concurrent period, nonparticipants, classic control group, etc.). We agree with this sentiment.
The fact that there were significant changes in opinions in one half of the issues leads us to believe that there is a great need for civil, structured discussion and honest and respectful public debate of the important issues facing DM. These discussions should take place at conferences, at other meetings, and in the pages of magazines.
Given the issues in the peer-reviewed literature, we encourage more space be devoted in peer-reviewed journals for letters to the editor. This would constitute an on-going public peer review of peer-reviewed literature.
A similar debate will be conducted at the Health Management Congress in the fall.