Abstract
The mechanism for quality management in disease management is one of the issues to be explored within the context of its development. USA has much experience in the development of disease management. This experience will serve as a useful reference and its analysis will bring us many suggestions. We observe in disease management in the USA the feature of robustness of market with huge variety of players and many kinds of purchasers, such as health plans, employers, and governments, service providers such as disease management organization, as well as accreditation organizations, and consultants. The US market benefits from the accumulated experience and practices over the period of a decade or more. Actions in developing the quality management mechanism include accreditation and initiatives by private organizations. Notably, the Disease Management Association of America (DMAA) has labored hard to establish consensus-based outcomes evaluation. US experience tells us that accreditation is useful, but has limitations and requires necessary experiences, and that while consensus on the evaluation of outcomes in disease management has not yet been firmly established, it could be formed through accumulated practices and an exchange of knowledge in a pragmatic approach. Quality management as knowledge management at a societal level or as part of the infrastructure is required. It is no small matter to purposefully create the mechanism of circulation and exchange of expertise and knowledge, and to integrate them.
