Research on the quality of care reveals a health care system that frequently falls short in its ability to translate knowledge into practice.
For several decades, the needs of the American public have been shifting from predominantly acute, episodic care to care for chronic conditions. Chronic conditions are now the leading cause of illness, disability, and death; they affect almost half of the U.S. population and account for the majority of health care expenditures.
Yet there remains a dearth of clinical programs with the infrastructure required to provide the full complement of services needed by people with heart disease, diabetes, asthma, and other common chronic conditions....The fact that more than 40% of people with chronic conditions have more than one such condition argues strongly for more sophisticated mechanisms to communicate and coordinate care....Yet physician groups, hospitals, and other health care organizations operate as silos, often providing care without the benefit of complete information about the patient's condition, medical history, services provided in other settings, or medications prescribed by other clinicians.
To initiate the process of change, the committee believes the health care system must focus greater attention on the development of care processes for the common conditions that afflict many people. A limited number of such conditions, about 15 to 25, account for the majority of health care services....Nearly all of these conditions are chronic. By focusing attention on a limited number of common conditions, the committee believes it will be possible to make sizable improvements in the quality of care received by many individuals within the coming decade.
In identifying these priority conditions, the agency (AHRQ) should consider using the list of conditions identified through the Medical Expenditure Panel Survey 2000. According to the most recent survey data, the top 15 priority conditions are:
Health care organizations, clinicians, purchasers, and other stakeholders should then work together to:
The language of the report is extremely technical and the findings are not as easily put into sound bites as the last IOM report (e.g., "98,000 deaths annually due to medical errors"). Nonetheless, this report promises to be a turning point in ushering out the era of cost-focused managed care.
Finally, hats off to the IOM in recognizing the crucial role that reimbursement reform must play to incentivize health care providers and DM companies.
WILL CONSUMERS DEMAND CLINICAL QUALITY?
A recent study suggests that the short answer to this question is a resounding "YES". VHA, a nationwide network of community-owned health care systems and their physicians, has published "Consumer Demand for Clinical Quality: The Giant Awakens".
CONCLUSIONS from the study:
1) Consumers are seeking
credible and meaningful clinical health care information and feel it is
important to be actively involved in their care or the care of their
RECOMMENDATIONS from the study:
1) Health care organizations
should actively and publicly assume accountability for clinical quality.
One aspect of this survey that is particularly interesting is the exploration of evidence-based medicine and evidence-based treatment messages presented directly to consumers. While a majority of consumers initially were not familiar with evidence-based approaches, the authors found that consumers could quickly understand the concepts and that future health care decisions could be dramatically influenced.
HEALTH LITERACY -- A SIGNIFICANT PROBLEM FOR PATIENTS WITH CHRONIC CONDITIONS
The issue of health literacy -- the set of skills needed to read, understand, and act on basic health care information -- is an issue championed by the American Medical Association, Pfizer, and other concerned organizations.
The estimated additional health care expenditures due to low health literacy skills are about $73 billion in 1998 health care dollars. This includes an estimated $30 billion for the population that is functionally illiterate plus $43 billion for the population that is marginally literate.
Health literacy is an especially significant challenge for patients with chronic conditions. ...patients with low health literacy and chronic diseases, such as diabetes, asthma, or hypertension, have less knowledge of their disease and its treatment and fewer correct self-management skills than literate patients....Individuals who rated their health as fair/poor were twice as likely to have inadequate health literacy compared with individuals who rated their health as good/excellent - 38.7% vs. 19.2%. Read more at AMA Foundation Tackling the Problem of Health Illiteracy.
EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT CHF DM
The National Pharmaceutical Council has compiled an extensive annotated bibliography on the benefits of disease management services for congestive heart failure patients.
SMART HOUSES FOR HEALTH CARE DELIVERY
"Today, we really do have the opportunity to tap into wires already in place in our homes for security and telecommunications purposes to enable constant monitoring, tracking, and transmitting of home care patient information to and from our homes." Read more in a forsightful article by Audrey Kinsella MA, MS.
COST REDUCTION REMAINS THE TOP BENEFIT PRIORITY FOR 2001
Deloitte and Touche has published its annual survey of certified benefit specialists, "Top 5 Benefit Priorities for 2001". For the second year in a row, "control health care costs" tops the list.
1996-2001 TOP BENEFIT
PRIORITIES FOR BENEFIT SPECIALISTS
Commentary: a sobering reality check when considered in light of the IOM "Crossing the Quality Chasm" study.
AHRQ EVIDENCE REPORT: TELEMEDICINE FOR THE MEDICARE POPULATION
The Agency for Healthcare Research and Quality (AHRQ) has issued a report evaluating telemedicine technologies. The report describes 3 categories of telemedicine: (1) Store-and-forward, (2) Self-monitoring/testing, and (3) Clinician-interactive services.
The Evidence-Based Practice Center (EPC) team identified 455 telemedicine programs, of which 362 are in the U.S. About 50 programs provide services in patient homes.
Conclusions from the study:
The evidence for the efficacy of telemedicine technology is less clear. The problem is not that studies have strong evidence against efficacy, but rather that their methodologies preclude definitive statements. Many of them have small sample sizes that preclude statistical power, and the settings of others may not be equivalent to clinical settings. Still others focus on patient populations that might be less likely than others to benefit from improved health services, such as people who have complex chronic diseases.
SURVEY REVEALS AMERICANS' CONCERNS ABOUT LIVING WITH CHRONIC CONDITIONS
Sponsored by Johns Hopkins University and the Robert Wood Johnson Foundation, Harris Interactive conducted a survey that reveals concerns about the quality of care for people with chronic conditions. For example, 72% of Americans say it is difficult for people living with chronic conditions to get necessary care from their health care providers.
Disclosure -- No BHT clients were mentioned this issue.
|[Top of Page] [Home] [About Us] [Services] [E-Newsletter] [Care Management] [Contact]|