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CCH® BENEFITS — 04/14/09

Integrated Health Care Can Improve Chronic Illness Treatment

from Spencer’s Benefits Reports: Improving care for people with chronic illnesses will require addressing barriers such as fragmented care, poor transitions between care settings, and payment that does not recognize the value of better integration of services, according to a recent report from AARP.

Other obstacles to improving care for those with chronic illnesses are “poor information systems” that make it difficult for medical providers to track patients over time, to integrate care among different providers and different care settings, and to track medication adherence and prevent drug interactions. In Chronic Care: A Call to Action for Health Reform, published on March 23, AARP reviews the difficulties that patients with chronic conditions and their caregivers reported experiencing in health care and how to improve care for this population.

Nearly one in four patients reported experiencing a medical error, and 61% of these said that the error resulted in a major problem for them. Slightly more than one-fifth of patients (21%) reported inadequate communication on the patient’s medical condition or treatment among their providers, and 20% said that this lack of communication had negatively affected their health. Fifteen percent of patients were readmitted within 30 days of discharge from a health care facility, and nearly the same proportion (14%) did not get a post-discharge follow-up appointment or they got one more than four weeks later.

Furthermore, in planning for the patients’ post-discharge care needs, 12.8% of patients reported that health care facility staff failed to take into account the patients’ and caregivers’ preferences. Nearly one-tenth of patients indicated that, upon discharge, they did not clearly understand symptoms that they should look for, and 7.4% did not know whom to call when their condition worsened. In addition, nearly one-fifth (18%) said that their transitional care was not well-coordinated.

Patients who are more engaged in managing their illness tend to experience fewer problems than less engaged patients, according to AARP. More engaged patients also tend to be more confident and knowledgable and to take more responsibility for their health than less motivated patients. Less engaged patients appeared sicker and had more encounters with the health care system than did more engaged patients. Also, less engaged patients were less likely than more engaged patients to look out for themselves and to follow their provider’s advice. Consequently, chronic care improvements could be achieved by identifying, supporting, and engaging less motivated patients, the AARP report suggested.

Caregivers of individuals with chronic medical conditions reported many of the same concerns as did patients. Caregivers’ reported concerns included poor communication among providers, lack of medical visits after hospital stays, patients’ lack of understanding about their medical instructions, unnecessary tests, and conflicting information. About 40% of caregivers said that they provided care for more than one person simultaneously, and more than two-thirds provided care for more than ten hours per month.

The AARP report concluded that “reducing the likelihood of poor transitions may require that providers identify and provide support to ‘high-risk’ patients with the following characteristics: more than five chronic conditions, less experience with the health care system, poor health status, need for assistance with patient care coordination activities, and low PAM [patient activation measure].”

The AARP study offered the following key steps for improving care coordination for people with chronic illnesses:

• Develop and adopt more effective and efficient care delivery models.
• Incorporate best practices in medical practices through certification and continuing education.
• Engage and empower patients to manage their conditions.
• Support and engage caregivers as partners in patient care.
• Encourage “wise use” of medications.
• Improve care coordination through adoption of health information technology and better tools for patients to manage their illnesses, including informed decision-making and support.
• Change payment policy to reward providers for working together toward improved care and better outcomes.
• Maximize the existing health care work force through interdisciplinary teams and nurses and pharmacists as team leaders.
• Make medications more affordable to help patients adhere to their necessary treatments.

For more information, visit http://www.aarp.org.

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