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DM Web site goes beyond national guidelines to include real-world ideas


While healthcare is highly competitive from a business perspective, when it comes to the actual delivery of care, everyone is on the same team. The ultimate goal is to provide the best possible care at the lowest possible cost, and that's exactly why the Cleveland Clinic created its Disease Management Project.

"We wanted to create an online, virtual textbook of medicine," says William D. Carey, MD, a gastroenterologist/hepatologist who currently is the director of the Cleveland Clinic's Center for Continuing Education. "While there are other medical resources on the Internet, we wanted ours to be a little different-not just a repository of clinical information, but one that reflects the use of chronic disease treatment in the real world."

Most online DM programs have focused largely on the end user, helping patients self-manage common afflictions such as asthma and diabetes. While such programs certainly have had their successes, they require a healthy dose of motivation by patients to be useful. Al Lewis, executive director of the Disease Management Purchasing Consortium and a member of the editorial advisory board for MANAGED HEALTHCARE EXECUTIVE, carefully tracks patient usage of online DM resources and says there is no growth in that category.

Because physicians have so much contact and credibility with their patients, they are in a unique position to encourage wellness, prevention and healthier behavior, with the end result being better disease management, higher patient satisfaction and lower costs for the entire healthcare system.


The first chapters of the Clinic's DM project went online in 2002, made possible by a grant from the family of Eileen Cawley, a patient of Dr. Carey. "The Cawleys are a Cleveland-based family who wanted to do something to help their community, but also create a legacy that would be used to help people everywhere," Dr. Carey says. "One of the most wonderful aspects is that their gift is helping people with chronic conditions not just in Cleveland, but all over the country."

The Disease Management Project Web site contains more than 145 chapters on 13 disease states: allergy and immunology, cardiology, dermatology, endocrinology, gastroenterology, hematology/oncology, infectious diseases, nephrology, neurology, psychology and psychiatry, pulmonary disease, rheumatology, and women's health.

Approximately 15 additional chapters already have been commissioned and will be added to the Web site soon, and negotiations with a publishing company are underway in the hope that a print version will be available in about a year.

Each of the chapters on the Web site is authored by a Cleveland Clinic physician who is responsible for researching and listing national practice guidelines in the area of specialty. That doesn't necessarily mean that the authors have to agree with all of the information listed in their chapters, Dr. Carey says. "While they are responsible for presenting the accepted practice guidelines, we know how difficult it is to keep them current. Some accepted practices are dated almost as soon as they are published. As a result, we don't necessarily recommend everything in the guidelines. If, for whatever reason, authors disagree with those accepted practices, they are responsible for discussing why, such as presenting more recent findings.

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