Application of Evidence-Based Management to Chronic Disease Healthcare : A Framework

Purpose: This paper develops a framework for the application of evidence-based management to chronic disease healthcare. Design/methodology/approach: Chronic healthcare is specially characterized by recursive physician-patient interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology, and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the health care process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. We present a new theoretical framework that aids in answering this question. Findings: This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies 1) the critical areas in which managers can effect changes that improve patient outcomes, 2) the influence these areas can have on each other, as well as on patient and physician behavior, and 3) the mechanisms by which these influences are exerted. For each, we draw upon, and present the evidence in the literature. Ultimately, we recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, we hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.Originality/value: This model can be used by managers as a heuristic either ex-ante or ex-post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Lastly, the model serves to focus attention on specific questions for further research