Impact of Disease Management Programs on Hospital and Community Nursing Practice

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Executive SummaryAs the quality and cost evidence grows in support of disease management programs, a policy and reimbursement infrastructure is emerging.CMS has identified a group of chronic disease, including HIV, diabetes, and several chronic cardiac and respiratory conditions, that are placing a disproportionate economic toll on the health care system.In 2004, a communication to State Medicaid Directors from CMS noted that disease management programs may qualify as reimbursable medical services under Medicaid, including assessment and education regarding self-management techniques provided by nurses.Movements by various professional, regulatory, and industry associations in support of disease management programs and standards provide a strong indication for their future direction.Since the demand for nurses with disease management skills will likely increase, nursing school curricula will need to embrace efforts to prepare students with additional knowledge in psychological and learning theories to meet this challenge and seize the opportunity for reimbursement.

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