Disease management: what have we learned so far?

Disease management (DM) is becoming an increasingly important tool for use in end-stage renal disease (ESRD). The goal of a DM program is to offer a continuum of care that uses guidelines and case management protocols to prevent acute care episodes, achieve improved outcomes and reduce health care costs. This article reviews the theory behind DM, describes key components of DM programs and explains the financial incentives for DM in ESRD. Of key importance in the increasing role of DM for ESRD has been the development of nationally recognized guidelines, the effects of which are now beginning to emerge. At the same time, recent studies have identified targeted opportunities for DM programs to improve outcomes and costs, including anemia management, dialysis dose, and vascular access. DM, through the use of guidelines and targeted toward these and other areas, has the potential to significantly impact the quality of care provided to ESRD patients.