Chronic Disease Mgmt
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness – Institute of Medicine – 10 February 2015
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness – Institute of Medicine – 10 February 2015
The guidelines come with a new moniker: systemic exertion intolerance disease (SEID).
US panel redefines chronic fatigue syndrome – Nature News 11 February 2015
Recommendation to change name to systemic exertion intolerance disease ignites controversy.
Global status report on noncommunicable diseases 2014 – WHO – January 2015Read Full Post | Make a Comment ( Comments Off on Global status report on noncommunicable diseases 2014 – WHO – January 2015 )
Chronic diseases in Australia: the case for changing course – Mitchell Institute for Health and Education Policy, Victoria University – 29 October 2014
“The burden of chronic disease in Australia threatens to overwhelm the health budget, the capacity of health services and the health workforce. Much of that burden is preventable through effective, evidence-based changes to policy.
This is a background paper for the Mitchell Institute November 2014 policy forum Chronic diseases in Australia: The case for changing course. The paper, written by Dr Sharon Willcox with the Mitchell Institute and a national expert advisory group, provides the case for changing course in Australian policies.
It addresses the health and non-health factors contributing to the prevalence of chronic diseases and puts forward four major directions for change. We anticipate this paper will promote debate in the policy community and encourage new action on chronic disease.”Read Full Post | Make a Comment ( Comments Off on Chronic diseases in Australia: the case for changing course – Mitchell Institute for Health and Education Policy, Victoria University – 29 October 2014 )
Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014
“Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target “high-need, high-cost” patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.”
Toward Increased Adoption of Complex Care Management – NEJM – 7 August 2014Read Full Post | Make a Comment ( Comments Off on Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014 )
“As world leaders gather at the United Nations General Assembly to assess efforts made since 2011 in controlling noncommunicable diseases (NCDs) like heart disease, cancer, diabetes and chronic lung disease, the new WHO “Noncommunicable diseases country profiles 2014″ show progress has been insufficient and uneven.”
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Patient, manager, expert: individual. Improving the sustainability of the healthcare system by removing barriers for people with long-term conditions – College of Medicine – 17 June 2014
Recipes for Sustainable Healthcare
“A new Sustainable Healthcare Report led by the College of Medicine and AbbVie, with the support of health organisations and expert patients, was launched at the House of Commons on Tuesday 17th June.
The report makes recommendations for how the delivery of NHS care can be made more sustainable and help to improve outcomes for people living with long-term conditions.
Nearly 15 million people in England have a long-term condition such as diabetes, heart disease, dementia or asthma which in turn account for half of GP appointments and two thirds of outpatient and A&E visits. If the NHS can improve the support provided to those living with long-term conditions then not only will patients get better outcomes but the service will also benefit from important financial efficiencies.
Part of the mission of The College of Medicine is to work with health organisations, practitioners and patients to share evidence and experience that will shape future healthcare models.
The Sustainable Healthcare Report makes 12 recommendations for change across three areas:
1) Embedding a person-centred approach, which considers the individual rather than a siloed focus on their condition(s)
2) Helping patients to navigate the healthcare system and manage their condition with confidence
3) Using technology to improve the delivery of services and care closer to home and equipping patients to self-manage.”Read Full Post | Make a Comment ( Comments Off on Patient, manager, expert: individual. Improving the sustainability of the healthcare system by removing barriers for people with long-term conditions – College of Medicine – 17 June 2014 )
“The Commission conducted a first-of-its kind, comprehensive review of existing chronic disease prevention research and programs, commissioned 11 original research papers, and debated the findings in private meetings and public forums. The result was a series of five actionable recommendations to build a culture of health that incentivizes and encourages working-age Americans to make healthier choices.
The Recommendations represent a way forward, based on pathways and short- medium- and long-term measures of success, reflecting thorough strategies for change.”
… continues on the site
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Supporting people to manage their health: An introduction to patient activation – King’s Fund – 16 May 2014
” With 60 to 70 per cent of premature deaths caused by detrimental health behaviours, it is vital that people engage more with improving their own health. This paper introduces a way of conceptualising and measuring that engagement known as ‘patient activation’.
Patient activation can be used to reduce health inequalities and deliver improved outcomes, better quality care and lower costs. Drawing on US and UK-based evidence, the paper describes the robust patient-reported measure – the PAM – used to gauge patient activation. PAM measures an individual’s knowledge, skill, and confidence for self-management. Research shows that appropriately designed interventions can increase patients’ levels of activation, with associated health benefits. The paper explores how this is being achieved in practice and offers recommendations for extending early use of the PAM in the United Kingdom.”
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Comorbidities: a framework of principles for system-wide action – England – Department of Health – 29 April 2014
“This document sets out the current challenges faced in the health and social care system in treating people with 2 or more long term health conditions. It proposes changes to the system to improve care.”
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Living Well for Longer: National Support for Local Action to Reduce Premature Avoidable Mortality – England, Department of Health – 28 April 2014
“Sets out how the health and care system will become amongst the best in Europe at reducing levels of avoidable mortality
This document will help people understand how the national system as a whole is supporting local action to help people live well for longer.
It includes actions already taken in prevention, early diagnosis and treatment.
It focuses on the 5 big killers:
It includes examples of good practice and help for local commissioning and service delivery.”Read Full Post | Make a Comment ( Comments Off on Living Well for Longer: National Support for Local Action to Reduce Premature Avoidable Mortality – England, Department of Health – 28 April 2014 )
Accountable care organisations in the United States and England: Testing, evaluating and learning what works – King’s Fund – 27 March 2014
“The health system in England is facing a number of challenges including an ageing population, an increasing number of people with multiple, long-term conditions and a difficult financial climate. To meet these challenges, more integrated approaches to care delivery are needed to improve both the quality of care and patients’ experience.
More people now need care across a number of different settings – hospitals, primary care, clinics, nursing homes and home care agencies – which are not co-ordinated, resulting in duplication of cost and effort and gaps in information and communication. In the United States, accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time – have been developed to provide a more integrated approach to care.
Accountable care organisations in the United States and England describes the different types of ACOs emerging in the United States; presents some early evidence on their performance; assesses the future for ACOs; and discusses the implication of these developments for integrated care initiatives in England.”Read Full Post | Make a Comment ( Comments Off on Accountable care organisations in the United States and England: Testing, evaluating and learning what works – King’s Fund – 27 March 2014 )
“The Coalition for Collaborative Care is a group of individuals and organisations across the health, social care and voluntary sectors who want to make person-centred, coordinated care a reality for people living with long-term conditions. That means improving the relationship that people have in their day-to-day interaction with the NHS and social care so their care and support is organised around what matters to them.
We are doing this through the House of Care. The House of Care was developed and tested by the Year of Care programme and People Powered Health. It is a flexible blueprint that uses collaborative care and support planning and at the same time recognises the importance of non-medical, community-based activities and resources. This ‘more than medicine’ approach helps each person develop the knowledge, skills and confidence to manage their condition/s within a supportive community.”
.. continues on the site
Royal College of General Practitioners | Year of Care Partnerships | Nesta | National Voices | NHS England | NHS IQ | The Health Foundation | Diabetes UK | British Heart Foundation | ADASS | College of Social Work | more members coming soon…
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The Importance of Multimorbidity in Explaining Utilisation and Costs Across Health and Social Care Settings: Evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014
The Importance of Multimorbidity in Explaining Utilisation and Costs Across Health and Social Care Settings: Evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014
Since the inception of the NHS, an ever-present challenge has been to improve integration of care within the health care system and with social care. Many people have complex and ongoing care needs and require support from multiple agencies and various professionals. But care is often fragmented and uncoordinated, with no one agency taking overall responsibility, so it is often left to individuals and their families to negotiate the system as best they can. South Somerset’s Symphony is designed to establish greater collaboration between primary, community, acute and social care, particularly for people with complex conditions.
We examine patterns of health and social care utilisation and costs for the local population to identify which groups of people would most benefit from better integrated care. We analyse data to identify groups of people according to the frequency of occurrence of underlying conditions; the cost of care; and utilisation of services across diverse settings. The empirical identification strategy is supplemented by local intelligence gained through workshops with health and social care professionals about the appropriateness of existing patterns of provision. We employ two-part regression models to explain variability in individual health and social costs, in total and in each setting.
The Symphony Project has an anonymised individual-level dataset, spanning primary, community, acute, mental health and social care. This includes activity, costs, clinical conditions, age, sex and ward of residence for the entire population of 114,874 people in 2012. Each person’s morbidity profile is described using the United Health’s Episode Treatment Groups (ETG), which build upon ICD and Read codes.
We identify the frequency of conditions and co-morbidity profile of the entire population and, for the most frequent conditions, we assess utilization and costs of care across health and social care settings. For example, for those with asthma and diabetes, hospital costs account for the largest proportion of costs; in contrast, costs for those with dementia occur mostly in social care, mental health care and community care settings. For the population as a whole, we find that costs of health and social care are driven more by an individual’s morbidity profile than by their age. Data for those with the most frequent conditions were reviewed by local health and social care professionals and managers. It was decided to undertake more detailed analyses for those with diabetes or dementia. 5,676 people are recorded as having diabetes in South Somerset, with hypertension being the most common comorbidity. For those with a sole diagnosis of diabetes, costs are around £1,000 on average but as people are recorded as having more diagnoses, average costs increase progressively. Costs are also higher for older people and women.People with dementia account for only 0.92% of the South Somerset population, but the average annual cost for the 1,062 people with dementia is around £12,000. A high proportion of these costs are related to the provision of mental health, social and continuing care. Costs are higher the more co-morbidities a person has, and for people from more deprived areas. Age and gender do not explain variation in costs for people with dementia.
This work forms a basis for identifying groups that would most benefit from improved integrated care, which might be facilitated by integrated financial arrangements and better pathway management. The more co-morbidities that a person has, the more likely they are to require care across diverse settings, and the higher their costs. Our analysis identifies those groups of the population which are the highest users of services by activity and cost and provides baseline information to allow budgetary arrangements to be developed for these targeted groups.
The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014
The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014
Panos Kasteridis, Andrew Street, Matthew Dolman, Lesley Gallier, Kevin Hudson, Jeremy Martin and Ian Wyer
Since the inception of the NHS, an ever-present challenge has been to improve integration of care within the health care system and with social care. Many people have complex and ongoing care needs and require support from multiple agencies and various professionals. But care is often fragmented and uncoordinated, with no one agency taking overall responsibility, so it is often left to individuals and their families to negotiate the system as best they can. South Somerset’s Symphony is designed to establish greater collaboration between primary, community, acute and social care, particularly for people with complex conditions.”
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by Nick Goodwin, Anna Dixon, Geoff Anderson, Walter Wodchis
“Lessons from seven international case studies
Around the world, rapidly ageing populations are resulting in increased demand for health and social care services, which presents significant challenges for national health and care systems. Many have adopted an integrated care approach to meet the needs of older people with chronic or multiple conditions. This approach often involves a single point of entry – designating a care manager to help with assessing needs, sharing information, and co-ordinating care delivery by multiple caregivers (formal and informal).
This report synthesises evidence from seven case studies covering Australia, Canada, the Netherlands, New Zealand, Sweden, the United Kingdom and the United States. It considers similarities and differences of programmes that are successfully delivering integrated care, and identifies lessons for policy-makers and service providers to help them address the challenges ahead.”Read Full Post | Make a Comment ( Comments Off on Providing integrated care for older people with complex needs – King’s Fund – 30 January 2014 )
Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 – WHO – 4 December 2013
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Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013
“This report updates previous burden of disease analysis undertaken in 2001 and 2007, and shows little progress is being made in preventing and managing osteoporosis in Australia. With an ageing population, it is now critical that real steps are taken to address this silent and often underdiagnosed disease affecting women and men that is costing governments, the community and comes at a great personal cost to the individuals affected.
The new information in this report on the current and future costs of osteoporosis in Australia will aid government policy makers, funding bodies, clinicians, researchers and health care organisations in assessing the importance of reducing osteoporosis and osteoporosis – related fractures, promoting bone health and in identifying future resource needs.”Read Full Post | Make a Comment ( Comments Off on Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013 )
Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program – Agency for Healthcare Research and Quality (ACHS) – August 2013
Extract from the executive summary
“A large and growing number of clinical services are delivered in ambulatory care settings such as physician offices, hospital-based outpatient clinics, and public health and other types of clinics. Patients seen in ambulatory settings vary widely in terms of health status and the types and severity of illnesses. Ambulatory care is often logistically complex, depending upon coordination and exchange of information both within and across organizations to address patients’ interrelated medical care and social support needs. Ambulatory care providers must also help patients navigate effectively and efficiently through the health care system to achieve optimal outcomes, in accordance with patient preferences. Appropriate implementation and use of health information technology (IT) systems such as electronic health records (EHRs), personal health records (PHRs), and health information exchange (HIE) systems can support the delivery of ambulatory care. These systems can provide clinicians with information and decision support, engage patients and support self-management, and facilitate communication among clinicians and between clinicians and patients.
In 2007, the Agency for Healthcare Research and Quality (AHRQ) launched the Ambulatory Safety and Quality (ASQ) program to foster research on how to improve the safety and quality of ambulatory health care in the United States. This report is the fifth in a series of reports highlighting findings and lessons from the health IT-focused ASQ program initiatives. It summarizes the experiences and findings from those initiatives, organized according to key aspects of ambulatory care that can be supported and improved through the use of health IT.”
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Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013
Lewis GH, Georghiou T, Steventon A, Vaithianathan R, Chitnis X, et al. Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis. Final report. NIHR Service Delivery and Organisation programme; 2013.
Extract from the executive summary
Health care systems in many developed countries are currently under financial strain because of ageing populations, the rising prevalence of various chronic diseases, and budgetary constraints resulting from the global economic downturn.
The costs of providing health care are highly skewed across the population, with a small number of patients accounting for a large proportion of expenditure. Since unplanned hospital admissions account for a high proportion of costs, considerable resources could potentially be invested in providing preventive care for a relatively small number of costly patients and yet still potentially yield net savings overall from averted future hospital costs. In practice, however, such savings have been difficult or impossible to demonstrate.
One reason why preventive interventions may be unsuccessful at reducing demand is if they are offered to patients who are at insufficiently high risk of future unplanned hospital admission. In 2005, the Department of Health commissioned two “case finding” tools for improving the identification of high-risk patients in England. Known as “PARR” and the “Combined Model”, these predictive risk tools are now used in many parts of the country to select which high-risk patients should be offered a hospital-avoidance intervention.
One such intervention is the “virtual ward”. This model of care uses the staffing, systems and daily routines of a hospital ward to deliver preventive care to patients in their own homes in the aim of mitigating their risk of unplanned hospitalisation. Whilst virtual wards have been introduced in many parts of the UK and overseas, their efficacy and cost-effectiveness has yet to be determined.”
Related Article from the International Journal of Integrated CareRead Full Post | Make a Comment ( Comments Off on Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013 )
“The costs of caring for people with age-related chronic and complex medical conditions are high and will continue to rise with population ageing. Yet people with multiple health and social care needs often receive a very fragmented service, resulting in less than optimal care experiences, outcomes and costs. Many countries have developed strategies to improve care co-ordination, but these have often failed to achieve their objectives. There is also a general lack of knowledge about how best to apply (and combine), in practice, the various strategies and approaches to care co-ordination.
This report presents the findings from a two-year research project funded by Aetna and the Aetna Foundation, which aimed to understand the key components of effective strategies employed by studying five UK-based programmes to deliver co-ordinated care for people with long-term and complex needs. It elicits some key lessons and markers for success to help identify how care co-ordination might be transferred from the UK to the US context.”Read Full Post | Make a Comment ( Comments Off on Co-ordinated care for people with complex chronic conditions – King’s Fund – 24 October 2013 )
Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults: Workshop Summary – Institute of Medicine – 2013
Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults is the summary of a workshop convened in June 2013 by the Forum on Aging, Disability, and Independence of the Institute of Medicine and the National Research Council to examine the financing of long-term services and supports for working-age individuals with disabilities and among individuals who are developing disabilities as they age. The workshop covered both older adults who acquire disabilities and younger adults with disabilities who may acquire additional impairments as they age, the target population of the Forum’s work. The challenges associated with financing long-term services and supports for people with disabilities impacts all age groups. While there are important differences between the characteristics of programs developed for different age groups, and specific populations may have different needs, this workshop addressed the financing sources for long-term services and supports in general, noting specific differences as appropriate.
The financing of long-term services and supports has become a major issue in the United States. These are the services and supports that individuals with disabilities, chronic conditions, and functional impairments need in order to live independently, such as assistance with eating, bathing, and dressing. Long-term services and supports do not include the medical or nursing services required to manage health conditions that may be responsible for a disabling condition. At least 11 million adults ages 18 and over receive long-term services and supports. Only a little more than half of them – 57 percent – are ages 65 or older. One study found that about 6 percent of people turning 65 in 2005 could expect to have expenses of more than $100,000 for long-term services and supports. Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults discusses the scope and trends of current sources of financing for long-term services and supports for working-age individuals with disabilities and older adults aging into disability, including income supports and personal savings. This report considers the role of families, business, and government in financing long-term services and supports and discusses implications of and opportunities for current and innovative approaches.”Read Full Post | Make a Comment ( Comments Off on Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults: Workshop Summary – Institute of Medicine – 2013 )
Focus on preventable admissions: Trends in emergency admissions for ambulatory care sensitive conditions, 2001 to 2013 – The Health Foundation – October 2013
“This QualityWatch report, published in partnership with the Nuffield Trust, explores patterns of emergency admissions across England for people with ambulatory care sensitive conditions.
For many years, clinicians, managers and policy-makers have tried various strategies to reduce hospital admissions, but rates have continued to increase. A particular focus has been on patients with conditions where timely access to high quality primary and preventive care can avoid the need for hospital admission in most cases.
These conditions are known as ambulatory care sensitive (ACS). Aggregate rates of emergency admissions for ACS conditions are commonly used to measure how well the health system is preventing unplanned hospital use. We were interested to understand how these rates varied across areas, and how they have changed over time – particularly in relation to the recent financial constraints introduced in the NHS.”
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Chronic disease management: the role of private health insurance – Parliament of Australia – 4 October 2013Read Full Post | Make a Comment ( Comments Off on Chronic disease management: the role of private health insurance – Parliament of Australia – 4 October 2013 )
Delivering better services for people with long-term conditions: Building the house of care – King’s Fund – October 2013
Extract from the key messages:
“The management of care for people with long-term conditions should be proactive, holistic, preventive and patient-centred. This report describes a co-ordinated service delivery model – the ‘house of care’ – that incorporates learning from a number of sites in England that have been working to achieve these goals.
The house of care model differs from others in two important ways: it encompasses all people with long-term conditions, not just those with a single disease or in high-risk groups; and it assumes an active role for patients, with collaborative personalised care planning at its heart. Implementing the model requires health care professionals to abandon traditional ways of thinking and behaving, where they see themselves as the primary decision-makers, and instead shifting to a partnership model in which patients play an active part in determining their own care and support needs.”Read Full Post | Make a Comment ( Comments Off on Delivering better services for people with long-term conditions: Building the house of care – King’s Fund – October 2013 )
Making the Case for Change: Advancing the NWT Chronic Disease Management Strategy – Canadian Foundation for Healthcare Improvement – 26 September 2013
NWT = Northwest Territories – has one of the highest burden of diseases in Canada
“A new report released by the Northwest Territories Department of Health and Social Services (DHSS) in partnership with the Canadian Foundation for Healthcare Improvement (CFHI) provides a detailed strategy for reducing the rate and impact of chronic disease in the region. It highlights the successes, challenges and lessons learned through three improvement projects focused on renal disease, mental health and diabetes.”
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Clinical guidelines for chronic conditions in the European Union – European Observatory on Health Systems and Policies – 2013
Edited by Helena Legido-Quigley, Dimitra Panteli, Josip Car, Martin McKee and Reinhard Busse
2013, xxviii + 229 pages
ISBN 978 92 890 0021 5
“Chronic noncommunicable diseases make up a large part of the burden of disease and make a huge call on health systems’ resources. Clinical guidelines are one of the ways European countries have tried to respond and to ensure a long-term perspective in managing them and addressing their determinants. This book explores those guidelines and whether they actually affect processes of care and patients’ health outcomes. It analyses:
the regulatory basis, the actors involved and processes used in developing clinical guidelines across Europe;
innovative methods for cost-effective prevention of common risk factors, developing coordinated patient-centred care and stimulating integrated research;
the strategies used to disseminate and implement clinical guidelines in various contexts; and
the effectiveness of their utilization.
This study reviews for the first time the various national practices relating to clinical guidelines in 29 European countries (the European Union (EU), Norway and Switzerland). It shows that, while some have made impressive progress, many are still relying on sporadic and unclear processes. The level of sophistication, quality and transparency of guideline development varies substantially across the region, even when the system for producing guidelines is well established. There are nevertheless clear examples that – if shared – can assure and improve quality of care across Europe.”
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Sustaining and spreading self-management support: Lessons from Co-creating Health phase 2 – The Health Foundation – September 2013
“This report contains the independent evaluation of the second phase of our Co-creating Health improvement programme. The evaluation, conducted by Firefly, provides valuable insight into how to sustain changes in clinical practice to more effectively support people with long-term conditions.
Through the Co-creating Health programme, the Health Foundation has invested £5 million over five years to test how to embed and sustain self-management support in primary and secondary care across a range of long-term conditions. The Co-creating Health model incorporates self-management training for people with long-term conditions, training in self-management support skills for clinicians, and a service improvement programme to put systems and processes in place to support patients and clinicians in their self-management activities.
Firefly’s evaluation of the programme concludes that to have the best chance of success there needs to be a strategic, whole-system approach to implementation of self-management support. The evaluation also highlights:
the benefits of training teams rather than individuals
the importance of support from senior leadership within the clinical community
the added value of integrating with concurrent initiatives
the value of providing support for both patients and clinicians after their initial self-management training as they seek to embed new habits.
The Co-creating Health model for supporting self-management can have a profound and positive effect on patients, clinicians and health services but, as the evaluation shows, making the necessary changes can be hugely challenging. However, Co-creating Health offers a theoretically robust, well evaluated model with tried and tested training, techniques and tools to successfully support people to self-manage.”
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“People with diabetes admitted to hospitals are nearly six times more likely than other patients to have wounds that don’t heal properly, reports the Canadian Institute for Health Information (CIHI).
In fact, diabetes doubles the risk of infections after operations and makes patients nearly 40 times more likely than other patients to develop wounds due to poor blood circulation.
This chronic illness was linked to more than 2,000 foot amputations in 2011–2012, many of which could have been avoided if proper wound care management and prevention had been in place.
CIHI’s unique study looked at persistent or “compromised” wounds—not only those infected or otherwise not healing, but also bed sores—among Canadians in hospitals, receiving home care and in long-term care during that same period.
“Compromised wounds are a burden to our health system,” said Kathleen Morris, CIHI’s Director of Health System Analysis and Emerging Issues. “They can be extremely painful and cause mobility problems and distress for patients.”
While any Canadian can be subject to a poorly healing wound, Compromised Wounds in Canada highlights the increased risks associated with chronic illnesses such as diabetes. It also reveals clear opportunities to reduce the frequency of occurrence.”
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An uncertain age: Reimagining long term care in the 21st century – KPMG commissioned by the Lien Foundation – May 2013Read Full Post | Make a Comment ( Comments Off on An uncertain age: Reimagining long term care in the 21st century – KPMG commissioned by the Lien Foundation – May 2013 )
“This publication contains the first biomedical results from the 2011-13 Australian Health Survey. It presents information on biomarkers of chronic disease, including objective prevalence rates for biomedical risk factors for cardiovascular disease, diabetes and chronic kidney function. The information is available by a range of demographic variables and health risk factors. Information on nutrition biomarkers, such as vitamin D, iron and iodine, will be released in late 2013.”Read Full Post | Make a Comment ( Comments Off on Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12 – ABS – 5 August 2013 )
Putting innovation to work: improving chronic disease management and health system sustainability in Ontario – The Better Care Faster Coalition – June 2013
“Better Care Faster believes that more effectively identifying and disseminating high-value breakthroughs in chronic disease management (CDM) offers one of the best hopes for our province to improve the quality and efficiency of our public health care system.”Read Full Post | Make a Comment ( Comments Off on Putting innovation to work: improving chronic disease management and health system sustainability in Ontario – The Better Care Faster Coalition – June 2013 )
Improving Primary Health Care Through Collaboration: Briefing 3 -Measuring the Missed Opportunity – Conference Board of Canada – June 2013
17 pages, Briefing by Thy Dinh, Fares Bounajm
“This briefing is the third in a series of four that aims to provide an analysis of the impact of interprofessional teams on the Canadian primary health care system.
The existing and future health care needs of the Canadian population are largely about managing chronic conditions. Better management of patients with chronic conditions in the primary care system can reduce the burden in the more costly acute or hospital care system. If the enhanced use of interprofessional primary care (IPC) teams can be shown to be cost-effective, they should become the preferred model of care for chronic conditions in all provinces and territories.
This briefing aims to assess whether IPC teams could become a central component of a health care services delivery strategy for chronic conditions. It provides the results of an empirical analysis of the impact of enhanced IPC teams on the health and economic burden of Type 2 diabetes and depression in Canada.
Other briefings in the Improving Primary Health Care Through Collaboration series:
Briefing 1—Current Knowledge About Interprofessional Teams in Canada
Briefing 2—Barriers to Successful Interprofessional Teams”
“In Progress Report 2013: Health care renewal in Canada, the Health Council reports on the progress made by jurisdictions in five priority areas of the health accords:
access and wait times;
primary health care reform and electronic health records;
disease prevention, health promotion and public health; and
Enabling people to live well: fresh thinking about collaborative approaches to care for people with long-term conditions – The Health Foundation – May 2013
“This is the report of a research project undertaken by Professors Vikki Entwistle and Alan Cribb.
critically analysed the ways that collaborative approaches are currently described
started to examine what goes on in practice when clinicians and patients work together in ways they appreciate as meaningfully collaborative.
The project used a combination of philosophical analysis and discussions with clinicians and patients experienced in collaborative approaches to managing long-term conditions.
In the report, the authors reflect on clinicians’ and patients’ experiences and draw on ideas from development economics and social justice. They argue that thinking in terms of people’s capabilities, and how they live in relationship with others, may be able to help us understand and overcome some of the barriers to more collaborative working between health professionals and patients with long-term conditions.
The report also makes clear that, while the ways people describe collaborative approaches to healthcare can be helpful in indicating how care could be delivered differently, they can also be counter-productive. Current descriptions are developed within the dominant and traditional way of thinking about the patient-health professional relationship and this could be limiting the uptake and effectiveness of more collaborative ways of working.
Making care truly person-centred requires radically different ways of thinking. The ideas explored in this report suggest fresh ways of thinking about how patients and clinicians can work together in a meaningful partnership. Thinking in terms of capabilities and relational autonomy will not resolve tensions between patient and clinician priorities, but these concepts can help support much-needed discussion.”Read Full Post | Make a Comment ( Comments Off on Enabling people to live well: fresh thinking about collaborative approaches to care for people with long-term conditions – The Health Foundation – May 2013 )
Evaluation of the first year of the Inner North West London Integrated Care Pilot – Nuffield Trust – 17 May 2013
“This report outlines the findings of our evaluation of the Inner North West London Integrated Care Pilot, which aimed to develop new forms of care for older people and those with diabetes.”Read Full Post | Make a Comment ( Comments Off on Evaluation of the first year of the Inner North West London Integrated Care Pilot – Nuffield Trust – 17 May 2013 )
The Business Case for People Powered Health – Nesta – April 2013
“The Business Case for People Powered Health describes the specific investments required to create services with a People Powered Health approach, and the practical benefits that can be achieved as a result.
The NHS in England could realise savings of at least £4.4bn a year if it adopted People Powered Health innovations that involve patients, their families and communities more directly in the management of long term health conditions. These savings are based on the most reliable evidence and represent a 7% reduction in terms of reduced A&E attendance, planned and unplanned admissions, and outpatient admissions..
There is therefore both a social and financial imperative to scale the People Powered Health approach.
The People Powered Health approach involves five areas of practice: More than medicine (new services), People helping people (peer support), Redefining consultations, networks and partnerships, and user co-design and co-delivery. The most robust research literature focuses on two of these – redefining consultations and peer support – and suggests these types of interventions can improve health outcomes in all the most common long-term conditions, with patients more stable, less prone to exacerbation and demonstrating improvements in their core clinical indicators. As a result, there is a reduction in the cost of delivering healthcare of approximately 7 per cent of the commissioning budget – through decreasing A&E attendances, reducing hospital admissions, reduced length of stay and decreased patient attendances. Putting this into practice would save the NHS £4.4 billion across England.
However, we think that the People Powered Health approach could achieve even higher savings. This is both because the median of all available evidence, including less robust studies, suggests the cost of managing patients with long-term conditions could be reduced by up to 20 per cent, and the experience of the six sites suggests People Powered Health interventions are enablers of each other at scale.”
“People Powered Health is an approach that can improve quality of life and save the NHS money
The health system is going through significant upheaval and crisis provoked by the combined impact of the NHS reforms and the Francis Inquiry. The result is a sense of unease and uncertainty despite the NHS ranking excellently in international terms. At a recent Lord Darzi discussion on primary care, the mood was summed up as: ‘Why does it feel so bad, if we’re actually doing so well?’
Part of the answer is that the NHS is good at dealing with acute and infectious disease, but is still finding its way towards a model that effectively manages long-term conditions. Another element is the challenge of nurturing compassion in large, formal institutions, where staff are under considerable financial pressure.
People Powered Health is an approach to health and care that addresses both issues.”
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“As governments shift from episodic acute care to long-term chronic care, Portraits 2013 provides critical information to support the role of home care within this transformation. A valuable tool for health policy planners, researchers, administrators and service providers, it provides a straightforward source of essential home care facts and figures on:
· Home care legislation, evolution and priorities
· Access, eligibility and utilization
· Funding trends and delivery models
· Indicators, quality, research and technology
· Human resources and family caregivers
· Initiatives and challenges
Portraits 2013 is the third edition of the Portraits of Home Care in Canada series, which includes publications in 2003 and 2008. This edition builds on the previous ones to expand our picture of home care, with more comprehensive data and new information on service delivery models, quality and accountability, and the impact of technology on home care across Canada. Information sources for Portraits 2013 include key informants from provincial, territorial and federal governments, and published reports. It is not a research paper and intentionally does not contain recommendations to support any particular advocacy agenda.”Read Full Post | Make a Comment ( Comments Off on Portraits of home care in Canada 2013 – Canadian Home Care Association – 4 April 2013 )
A Compendium of Tools from Maine, Oregon, and Humboldt County, California
“A new toolkit showcases how primary care practices are involving patients in quality improvement efforts as part of Aligning Forces for Quality (AF4Q), the Robert Wood Johnson Foundation’s signature effort to lift the quality of care in targeted communities across the United States. The “Engaging Patients in Improving Ambulatory Care” toolkit features videos and an extensive compendium of adaptable resources from three AF4Q alliances—Maine, Oregon, and Humboldt County, Calif.—to introduce the concept of partnering with patients and families in primary care and share lessons learned.”
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Improving Transitions of Care in LTPAC: An Update from the Theme 2 Challenge Grant Awardees – Office of the National Coordinator for Health Information Technology – 21 March 2013
LTPAC = long-term and post-acute care
“the grantees have identified strategies and approaches that can be widely adopted by communities seeking to improve transitions of care to and from LTPAC providers:
• Common processes and appropriate connection points for clinical information transfer between hospitals and LTPAC providers
• Recommendations for hospital and LTPAC provider data needs
• Strategies to promote the use of standards based technology to create, transmit and view clinical documents of relevance to LTPAC
• Approaches to engage LTPAC providers where they are today across the health IT adoption spectrum (from high adoption to no adoption)
In addition, the grantees have encountered challenges that will need to be addressed by any community seeking to address this issue:
• Uneven adoption of non-certified electronic health records makes connections between acute and post acute care providers challenging and labor intensive
• High staff turnover rates create implementation and ongoing operational challenges”
Read Full Post | Make a Comment ( Comments Off on Improving Transitions of Care in LTPAC: An Update from the Theme 2 Challenge Grant Awardees – Office of the National Coordinator for Health Information Technology – 21 March 2013 )
CMS unveils chronic conditions dashboard [US] – AHA News – 28 March 2013
“The Centers for Medicare & Medicaid Services today released a new dashboard to help researchers, policymakers and providers improve care for chronic illnesses. The online tool provides national comparison data on the prevalence of chronic conditions, as well as Medicare costs and utilization measures for beneficiaries with chronic conditions, using data from CMS’ Chronic Conditions Data Warehouse. “The Dashboard is a major step forward to help people living with multiple chronic conditions,” said Department of Health and Human Services Assistant Secretary for Health Howard Koh, M.D. “This web-based tool provides new and critical data that can help us develop better patient-centered approaches to improve health outcomes, lower costs, and maximize quality of life.” “Read Full Post | Make a Comment ( Comments Off on Chronic conditions dashboard – Centers for Medicare and Medicaid Services (CMS) [US] )
National Committee for Quality Assurance [US] sets up accreditation for practitioners to become certified as a Patient-Centered Medical Home Certified Content Expert for physician specialists outside of primary care
National Committee for Quality Assurance [US] sets up accreditation for practitioners to become certified as a Patient-Centered Medical Home Certified Content Expert for physician specialists outside of primary care
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Making integrated care happen at scale and pace: Lessons from experience – King’s Fund – 21 March 2013
“The current fragmented services in health and social care fail to meet the needs of the population. A shift to an approach that develops integrated models of care for patients, especially older people and those with long-term conditions, can improve the patient experience and the outcomes and efficiency of care.
Making integrated care happen at scale and pace: Lessons from experience is intended to support the process of converting policy intentions into meaningful and widespread change on the ground. The authors summarise 16 steps that need to be taken to make integrated care a reality and draw on work by The King’s Fund and others to provide examples of good practice.
There are no universal solutions or approaches to integrated care that will work everywhere and there is also no ‘best way’ of integrating care, and the authors emphasise the importance of discovery rather than design and of sharing examples of good practice when developing policy and practice.
Finally, the paper acknowledges that changes are needed to national policy and to the regulatory and financial frameworks for local leaders to fully realise a vision of integration.”Read Full Post | Make a Comment ( Comments Off on Making integrated care happen at scale and pace: Lessons from experience – King’s Fund – 21 March 2013 )
Health IT in long-term and post-acute care – The Office of the National Coordinator for Health Information Technology [US] – 15 March 2013
“This issue brief provides an overview of the opportunities for long-term and post-acute care (LTPAC) providers to use health information technology (IT) to improve care delivery and health outcomes while reducing total cost of care. The first section defines the issue. The second section provides background information on the current landscape of health IT in LTPAC and an overview of the challenges and opportunities to improve care coordination and patient outcomes through the use of health IT in LTPAC settings. The third section highlights promising examples of how health IT tools and standards-based health information exchange (HIE) are enabling patient-centered care. The fourth section summarizes many health care transformation programs that represent opportunities for LTPAC providers to be integrated into health IT-enabled health care delivery and payment programs. The fifth section summarizes the key considerations for the LTPAC community today in deciding how to use health IT to transform care and the sixth and final section provides suggestions for additional resources to aid the LTPAC community as providers implement tools and standards-based HIE.”Read Full Post | Make a Comment ( Comments Off on Health IT in long-term and post-acute care – The Office of the National Coordinator for Health Information Technology [US] – 15 March 2013 )
Commissioning high quality care for people with long term conditions – an action research study – Nuffield Trust – March 2013
NHS Institute for Health Research funded work
“This project explores how services for people living with long-term conditions (e.g. asthma, diabetes and high blood pressure) can be planned, funded and put in place (commissioned) so that the quality of those services is as high as possible. The research takes as its starting point the fact that there is ample evidence about how, in theory, health services should be commissioned. This study wishes to focus instead on the practical day-to-day experience of doctors, managers, user and carer representatives and others within primary care trusts who are responsible for working together to commission long-term condition services.” … continuesRead Full Post | Make a Comment ( Comments Off on Commissioning high quality care for people with long term conditions – an action research study – Nuffield Trust – March 2013 )
Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs – AHRQ – January 2013
Totten AM, Wagner J, Motu’apuaka M, Hickam DH, Guise JM. Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs. Future Research Needs Paper No. 30. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC035-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2013.
In 2010, the Agency for Healthcare Research and Quality (AHRQ) charged the Oregon Evidence-based Practice Center with conducting a Comparative Effectiveness Review (CER)1 to assess the effectiveness of outpatient case management as an intervention strategy for chronic illness management.
The Key Questions the review addressed were:
Key Question 1. In adults with chronic medical illness and complex care needs, is case management effective in improving:
1a. Patient-centered outcomes, including mortality, quality of life, disease-specific health outcomes, avoidance of nursing home placement, and patient satisfaction with care?
1b. Quality of care, as indicated by disease-specific process measures, receipt of recommended health care services, adherence to therapy, missed appointments, patient self-management, and changes in health behavior?
1c. Resource utilization, including overall financial cost, hospitalization rates, days in the hospital, emergency department use, and number of clinic visits (including primary care and other provider visits)?
Key Question 2. Does the effectiveness of case management differ according to patient characteristics, including but not limited to: particular medical conditions, number or type of comorbidities, patient age and socioeconomic status, social support, and/or level of formally assessed health risk?
Key Question 3. Does the effectiveness of case management differ according to intervention characteristics, including but not limited to: practice or health care system setting; case manager experience, training, or skills; case management intensity, duration, and integration with other care providers; and the specific functions performed by case managers?
The analytic framework (Figure A) outlines the targeted population, interventions, and outcomes for the review.”
Systems Approaches to Knowledge Mobilization: Scan of Initiatives – Prepared for: Chronic Disease Interventions Division Public Health Agency of Canada – September 2012
Prepared by: Jamie Gamble, Imprint Consulting Inc.
Extract from the Foreword:
“Preventing chronic disease is complex. Solutions require a multiplicity of players, in and outside of the health system, working together using integrated, multifaceted approaches. The more chronic disease prevention (CDP) efforts can be guided by „what works‟, the greater the chance of success. However, because what works for CDP is complex, more traditional approaches used for evidence-based medicine are not a good fit.
A promising new approach for mobilizing evidence and knowledge in order to improve CDP efforts, is to apply concepts and tools from complex systems science to better link evidence and action. This approach includes giving more attention to „system gaps‟ (as opposed to evidence gaps), better aligning the needs and interests of researchers and practitioners, focusing on systems that allow for continuous learning and adaptation, and implementing methods that enable real-time feedback about what is working, for whom, under what conditions and at what cost. In short, there is a need to develop approaches for mobilizing knowledge and evidence that better equip us to learn about what works in the dynamic and diverse environments within which CDP efforts are currently being undertaken.”
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WHO Member States make progress on noncommunicable diseases – 9 November 2012
“The first-ever global monitoring framework to combat several of the world’s biggest killers has been agreed this week by WHO Member States. The framework comprises nine voluntary global targets and 25 indicators to prevent and control diseases such as heart disease, diabetes, cancer, chronic lung disease and other noncommunicable diseases. The draft framework aims to focus efforts to address the impact of noncommunicable diseases and assess:
the progress made in reducing associated illness and death;
the reduction of exposures to the main risk factors for the diseases, including tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity; and
the response of national health systems to noncommunicable diseases”
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From vision to action. Making patient-centred care a reality – Richmond Group of Charities [UK] – 2012
Extract from the foreword:
“When our ten leading health and social care charities published our joint view on how high-quality, patient-centred, cost-effective care could be delivered, we were surprised how aligned our thinking was. We agreed five themes on which the post-reform NHS should be based
and within which productivity gains are possible:
• co-ordinated care
• patients engaged in decisions about their care
• supported self-management
• prevention, early diagnosis and intervention
• emotional, psychological and practical support.
Our shared vision has yet to be delivered. The Health Select Committee recently warned the government that if standards of quality and access are to be maintained, system redesign is needed, rather than salami-slicing existing services or incremental improvement (House of Commons Health Committee 2012). We agree.
As leading charities that both advocate for and support the care of people with health and social care needs, we renew our commitment to working with colleagues locally and nationally, in policy and in service delivery, to build a sustainable model for the NHS and its partners.”
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How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010
Extract from the introduction:
“This publication is the collective effort of ten of the leading health and social care organisations in the voluntary sector. Each organisation submitted evidence to The King’s Fund, which independently analysed and assessed each submission and worked with the organisations to establish a common position. Together we have identified the five key themes that the health and social care system must embrace to be sustainable and to ensure quality. The themes are:
•patients engaged in decisions about their care
•prevention, early diagnosis and intervention
•emotional, psychological and practical support”
… continuesRead Full Post | Make a Comment ( Comments Off on How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010 )
ADOPT Toolkit: Helping Organizations Design and Implement Health Technology – Center for Technology and Aging
“The Center for Technology and Aging’s ADOPT Toolkit will help you more quickly and easily design health technology-focused programs and to accelerate diffusion of proven technologies.
The tools on this website build on the Center’s broad research and real-world experience and are designed for organizations committed to using technology to dramatically improve chronic disease management.
Technologies that assist care coordination and improve the independence of older adults cover a very wide spectrum. The ADOPT Toolkit offers tools in four areas: Remote Patient Monitoring, Medication Optimization, Care Transitions, and Mobile Health.
Select a toolkit below and then a specific tool from that area’s page and you will discover practical guides, checklists, lessons learned, and other valuable resources. Tools are further organized into Workstreams that help to simplify the complex steps required to successfully deploy a technology.”Read Full Post | Make a Comment ( Comments Off on ADOPT Toolkit: Helping Organizations Design and Implement Health Technology – Center for Technology and Aging )
High-intensity primary care: lessons for physician and patient engagement – National Institute for Health Care Reform Research Brief no. 9 – October 2012
“To prevent costly emergency department visits and hospitalizations, a handful of care-delivery models offer high-intensity primary care to a subset of patients with complex or multiple chronic conditions, such as diabetes, congestive heart failure, obesity and depression. Early assessments of high-intensity primary care programs show promise, but these programs’ success in improving quality of care and lowering costs rests on the engagement of both physicians and patients. A number of factors can foster physician and patient engagement in high-intensity primary care programs, according to a new qualitative study by the Center for Studying Health System Change (HSC). For physicians, key factors include financial commitment and administrative support from health plans and well-designed financial incentives for quality and outcome improvements. In addition, allowing physicians to help identify patients who would benefit from intensive primary care may improve physician comfort and buy in. To encourage patient engagement, a personal invitation from physicians to join a high-intensity primary care program, as well as rapid access to physicians and care coordinators, appear to be highly successful approaches.”Read Full Post | Make a Comment ( Comments Off on High-intensity primary care: lessons for physician and patient engagement – National Institute for Health Care Reform Research Brief no. 9 – October 2012 )
Evaluating disease management programmes. Learning from diverse approaches across Europe – RAND – 2012
“The DISMEVAL consortium (Developing and validating disease management evaluation methods for European healthcare systems, a consortium of ten partners in seven countries led by RAND Europe), examined approaches to chronic disease management in 13 countries across Europe and tested the methods being used to evaluate these in six countries.”Read Full Post | Make a Comment ( Comments Off on Evaluating disease management programmes. Learning from diverse approaches across Europe – RAND – 2012 )
Peer Support in Long Term Conditions: the Basics – Mental Health Foundation – 27 September 2012
“Organisations delivering or planning to deliver peer support for people with long term conditions will be able to find out more about its benefits and good practice thanks to a new guidance by the Mental Health Foundation Peer Support in Long Term Conditions: the Basics.
The guidance was generated following a research project undertaken from 2010 to 2011. The research found that peer support activity for people with long term conditions across Scotland had a positive impact on people’s emotional and physical health but that access to such services was inconsistent. Support services also reported some challenges to integrate with statutory services and felt they often lacked credibility in the eyes of potential referrers including clinicians and beneficiaries.”
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“This review identifies, appraises and summarises the most effective evidence-based theories and programmes of health behaviour change for individuals with the following chronic diseases: diabetes, chronic obstructive airways disease, asthma, stroke and hypertension.”Read Full Post | Make a Comment ( Comments Off on Effective behaviour change in long-term conditions – NZ Ministry of Health – 2 October 2012 )
The Accountable Lead Provider. Developing a powerful disruptive innovator to create integrated and accountable programmes of care – RightCare Casebook [NHS] – July 2012
Professor Paul Corrigan and Dr Steven Laitner
Extract from the executive summary:
“Public experience of NHS services is marked by praise for the specific experiences of treatment but problems with the overall experience of service. Whilst most staff and leaders in the NHS recognise the severe problems caused by the organisation of care into episodes of care, there are few models of integrated care that have emerged which have sufficient integrative power to challenge the organisational distinction of episodic care. This is partly because those arguing for integration do so usually within the episodic paradigm but also because they want to develop a new model of integration without disrupting the old model of episodic care.
Here we argue for a strong integrator who is given the power through the contract to both deliver care and also to bring together the previously episodic providers of care into a single pathway. The lead provider in this model is given the responsibility through the contract for subcontracting for the various aspects of care. The contract demands of the lead provider that he carry out that role in such a way as to ensure all of the different aspects of care are fully integrated.”
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Behavioral Health Roundtable: Using Information Technology to Integrate Behavioral Health and Primary Care – Office of the National Coordinator for Information Technology – September 2012
Extract from the introduction:
“The burden of behavioral health conditions (including mental illness and substance use disorders) in the United States remains great. Consider the prevalence and treatment of mental illness. By 2009, almost 20 percent of adults in the United States had suffered from a mental health condition at some point in their lives. Mental illness is a source of significant comorbidity in the chronically ill, particularly for patients with diabetes or cardiovascular disease. Diabetes patients, for instance, are twice as likely to suffer from depression as the general population. Mental illness is also associated with higher rates of substance abuse. In 2010, approximately 23 million people ages 12-64 reported symptoms of substance use disorders, while only 11 percent received treatment at a specialty facility. Moreover, a substantial volume of behavioral health care is delivered in primary care settings. General and internal medicine physicians cared for 34 percent of patients with a primary mental health diagnosis in 2008 alone. Given the burden of illness and the volume of behavioral health care delivered in primary care settings, better integration between behavioral health and primary care is needed.
Health information technology (health IT), including electronic health records (EHRs), personal health records (PHRs), health information exchange (HIE), mobile health, and other technologies that support health and wellness are key enablers of this integration. However, behavioral health clinicians currently have limited adoption of interoperable information systems. In a recent study, just over 20 percent of 505 behavioral health organizations surveyed indicated that they had fully adopted an EHR. Behavioral health organizations cited as barriers to EHR adoption concerns over initial productivity losses, lack of qualified IT and project management staff, provider resistance, and privacy laws.”
… continuesRead Full Post | Make a Comment ( Comments Off on Behavioral Health Roundtable: Using Information Technology to Integrate Behavioral Health and Primary Care – Office of the National Coordinator for Information Technology – September 2012 )
Multiple causes of death in Australia: an analysis of all natural and selected chronic disease causes of death 1997-2007 – AIHW – 23 August 2012
“Multiple causes of death data are useful for describing the role of all diseases involved in deaths. This bulletin is the first comprehensive application of multiple causes of death statistics to natural causes of death and specific chronic diseases of public health importance in Australia. It may be useful for guiding and improving policy for reducing deaths from these chronic diseases and for targeting future investment in health prevention. When describing patterns of causes of death using only the underlying cause, important cause information is overlooked. Analyses using multiple cause data complement routine descriptions of mortality that use only the underlying cause and offer broader insight into the disease processes occurring at the end of life.”
ISBN 978-1-74249-330-5; Cat. no. AUS 159; 25ppRead Full Post | Make a Comment ( Comments Off on Multiple causes of death in Australia: an analysis of all natural and selected chronic disease causes of death 1997-2007 – AIHW – 23 August 2012 )
Integrating healthcare in an internet age – Monash University – 17 August 2012
“A new online service has transformed the way patients access treatment and healthcare resources in the management of chronic disease, including diabetes and asthma.
Victorian Minister for Health Mr David Davis, in conjunction with Precedence Health Care (PHC), today launched a national project, Collaborative Care Cluster Australia (CCCA), established to create new mobile and online services that transform medical healthcare.
The core initiative of the CCCA project was a new online service, known as Chronic Disease Management-Net (cdmNet), developed to enable patients, their GPs and allied healthcare professionals to manage chronic disease through sharing medical histories, test results, up-dates on patients’ conditions, send referrals and set appointment reminders.”
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Chronic obstructive pulmonary disease (COPD) commissioning toolkit [NHS] – 1 August 2012
“The chronic obstructive pulmonary disease (COPD) commissioning toolkit is published for NHS commissioners and chief executives. It aims to make it easier to commission better outcomes for people with COPD by bringing together the clinical, financial and commercial aspects of commissioning in one place.
The toolkit does much of the hard work in the commissioning process including:
the development of best practice service specifications and costing tools
enabling a commissioner to spend more time having informed discussions with providers about service delivery
focusing on matters that will make the most difference to patients, rather than process or bureaucracy”
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An Interactive Preventive Care Record (IPHR): A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention – AHRQ – June 2012
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
Krist A, Rothemich S, Kashiri P, et al. An Interactive Preventive Care Record: A Handbook for Using Patient-Centered Personal Health Records To Promote Prevention. (Prepared by Virginia Commonwealth University, Department of Family Medicine, Virginia Ambulatory Care Outcomes Research Network (ACORN), under Grant No. R18 HS 017046.) AHRQ Publication No. 12-0051-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2012.
Extract from the introduction:
“Purpose of This Handbook
This step-by-step guide introduces you to—
●● Using personal health records (PHRs) to promote prevention.
●● Preparing your practice to use a PHR for promoting prevention.
●● Implementing and sustaining the use of a PHR for prevention.
The intended audience for this guide includes primary care practice personnel (e.g., office managers, clinicians, and nurses), practice leaders responsible for selecting informatics systems and ensuring that they are implemented well, and practice informatics staff.
Although the content of this guide can apply to using any PHR to promote prevention, we have focused on a specific type of PHR called an Interactive Preventive Health Record (IPHR). An IPHR is a highly advanced, patient-centered, evidence-based, patient portal focused on prevention. As information systems continue to advance, we believe that more PHRs will have interactivity functionality in the future.
Given the similarities between preventive and chronic care, the steps in this guide can also apply to using an IPHR to promote chronic disease management.
We have used organizational change theory to help determine the steps in this guide. While some steps may be specific to large practices and health systems, the concepts apply equally well to smaller primary care practices.”Read Full Post | Make a Comment ( Comments Off on An Interactive Preventive Care Record (IPHR): A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention – AHRQ – June 2012 )
Healthcare Cost and Utilization Project Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012 – 10 July 2012
U.S. Agency for Healthcare Research and Quality, HCUP
by Steiner C, Barrett M, Weiss A.
Extract from the introduction:
“40 percent of Americans. Heart disease and stroke are the first and fourth leading causes of death in the United States, and these diseases are among the most common and costly reasons for hospital admissions.2,3 The prevalence of cardiovascular and cerebrovascular diseases increases with age, with cardiovascular disease occurring in fewer than 20 percent of adults age 20-39 but more than 70 percent of adults age 60-79. Gender differences in these diseases also exist, with increasing rates by age of first major cardiovascular events for both men and women, but with a 10-year lag in the rates among women. The Affordable Care Act provides up to $100 million for community programs targeted at reducing chronic diseases, including heart disease and stroke, and another $40 million for statewide efforts focused on chronic diseases.
Timely information on trends for cardiovascular/cerebrovascular conditions and procedures provides analysts and policy makers baseline information and can be used to help evaluate the impact of health improvement efforts. A novel initiative from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) is used in this report to produce timely, current inpatient statistics on cardiovascular/cerebrovascular conditions and procedures.
The HCUP State Inpatient Databases (SID) from 2001 to 2010 include about 330 million inpatient discharges from 46 States. The list of statewide data organizations that contribute to HCUP is available in Appendix I. In this report we use the historical SID data with early 2011 data from 10 HCUP States to develop national quarterly projections of 2011 and 2012 inpatient statistics for:
- cardiovascular/cerebrovascular system conditions, overall
- five specific cardiovascular/cerebrovascular conditions
- cardiovascular/cerebrovascular system procedures, overall
- four specific cardiovascular/cerebrovascular procedures.”
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Chronious – Smart shirt monitors patients with chronic diseases – British Journal of Healthcare Computing – 29 June 2012
Chronious – An Open, Ubiquitous and Adaptive Chronic Disease Management Platform for COPD and Renal Insufficiency
“[Vicenza, Italy/ Medicine] – The EC funded Chronious project has developed a wearable remote monitoring system for the chronically ill. Developed by a consortium of 14 partners in eight European countries, the system is designed specifically for chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) patients, although it could easily be adapted for patients suffering from a variety of other long-term disorders.
Wearable heart, respiratory and activity monitoring sensors fitted to a light-weight T-shirt are used alongside external devices such as a digital weight scale, glucometer, blood pressure monitor, spirometer and air quality sensor in the patient′s home or room to measure vital, physical and environmental signs. These are connected to a mobile device such as a smartphone or PDA which in turn transmits the patient′s data to their care provider where it is analysed by software.
An open modular platform means different types of sensor can be used depending on the individual patient′s condition, making the system particularly adaptable to cases of comorbidity in which patients are living with two or more kinds of disorder such as CKD and diabetes. For CKD patients in particular, the Chronious team developed an innovative food intake program with a simple user interface so their diets can be closely monitored.”
… continues on the site
[Related information]Read Full Post | Make a Comment ( Comments Off on Chronious – Smart shirt monitors patients with chronic diseases – British Journal of Healthcare Computing – 29 June 2012 )
Telehealth and telecare service for COPD in Milton Keynes gives 28% return – British Journal of Healthcare Computing – 28 June 2012
“[Milton Keynes, UK/ Implementations] – A telehealth and telecare project implemented jointly by Milton Keynes health and social care services has resulted in improved quality of life for COPD patients, reduced hospital admissions, reduced visits to GPs and a long-term socioeconomic return of 28%.
The Milton Keynes project is part of the EU co-funded CommonWell project, which aims to overcome the communication gaps that separate health and social care service provision. Ten partners working in four member states — Milton Keynes in England, Bielefeld in Germany, Andalucia in Spain, Veldhoven in the Netherlands — co-operated to develop integrated service delivery to better support older people and those with long-term conditions.”
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Better Care: An Analysis of Nursing and Healthcare System Outcomes – Canadian Health Services Research Foundation – 18 June 2012
Gina Browne, et al
Problems arise when circumstances in the world change and conventional wisdom does not.
The present federally funded Canadian healthcare system has been driven principally by insured physicians and hospitals providing acute and episodic care that is a poor match to the changing demographics of persons with chronic disease living longer. The current health system consumes nearly one-half of provincial budgets.
There are solutions.
Recent analysis of 2005 expenditures by member countries of the Organisation for Economic Co-operation and Development on health and social services has empirically demonstrated that, after adjusting for overall gross domestic product per capita, it is the ratio of social service expenditures to health service expenditures that is better associated with improved outcomes in key health indicators and not the amount spent on health services.
Models of proactive, targeted nurse led care that focus on preventive patient self-management for people with chronic disease are either more effective and equally or less costly, or are equally effective and less costly than the usual model of care.
Additional key components of more effective and efficient healthcare models involve community based, nurse led models of care with an interdisciplinary team that includes the primary care physician. Such complex intervention requires specially trained or advanced practice nurses who supplement the care provided by physicians and other healthcare professionals. The proactive, comprehensive, coordinated model of community care is patient and family centered, targeted at community-dwelling individuals with complex chronic conditions and social circumstances.
Telemonitoring offers added effectiveness and efficiencies to healthcare, especially for remote populations.
The monitoring, evaluation and performance measurement system for the provision of healthcare should build on and link to pan-Canadian efforts already under way, such as the Longitudinal Health and Administrative Data Initiative.
Nurse-led models of care can be financed by costs averted from hospitals and emergency departments to home or community care. For example, after managing the current hospital caseload of patients awaiting alternative levels of care, the number of hospital beds could be reduced to free up funds for this reallocation of funding.
In Ontario alone, representing 37% of the Canadian population, independent reports estimate that millions of dollars could be saved in direct healthcare costs within one year by:
having nurses provide leading practices in home wound care
integrating nurse-led models of care to reduce high hospital readmissions by 10% for those with chronic conditions
providing 25% of palliative care in the home as opposed to in acute hospital settings
providing community care for patients in hospital designated as needing an alternative
providing proactive community care and patient self-management for those with congestive heart failure and other chronic conditions
Getting from problems to solutions is possible.”
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“This report evaluates the impact of telehealth on hospital use and mortality from the Department of Health’s Whole System Demonstrator pilots – believed to be the largest ever trial of telehealth.
In an era of financial challenge, telehealth – technology designed to help people with long-term conditions maintain their independence and avoid unnecessary hospitalisation – is often cited as vital to increasing the efficiency of health care delivery. But how robust is the evidence base?
The Department of Health’s Whole System Demonstrator trial – the largest of its kind conducted to date – analysed the effects of telehealth on over 3,000 patients across three areas in England: Cornwall, Kent and Newham.
The project strand led by the Nuffield Trust considered the impact of telehealth on patients’ hospital use and mortality in the three areas. In this research summary, Senior Research Analyst Adam Steventon and Head of Research Martin Bardsley highlight the main findings, whilst offering reasons for caution against being over-optimistic about what telehealth can deliver. They also provide some suggestions as to how future studies might best be designed.”
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CLHIA report on long-term care policy. Improving the accessibility, quality and sustainability of long-term care in Canada – Canadian Life and Health Insurance Association Inc – June 2012
Extract from the executive summary:
“This paper examines the future cost of long-term care in Canada over the next 35 years to support the baby boomers as they pass through old age and concludes that a significant funding gap exists. Conservatively, the cost in current dollars, of providing long-term care over this timeframe is almost $1.2 trillion. Current levels of government program and funding support will cover about $595 billion of this total cost. As a result, Canadians currently have an unfunded liability for long-term care of $590 billion which is the equivalent of about 95 percent all individual registered savings plans in Canada today.
Engaging in structural reform to transition patients to the most appropriate long-term care setting will not only enhance patient care, but will generate significant efficiency savings to governments of over $139 billion. These savings can then be re-invested into other long-term care initiatives to further improve patient care and address the funding shortfall. To this end, this paper proposes a number of recommendations organized around the following themes:”
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A Roadmap for Health IT in Long-Term and Post-Acute Care (LTPAC) 2012 – 2014 – Long-Term and Post-Acute Care Health IT Collaborative [US] – June 2012
“Priority Areas for Action
Care Coordination: LTPAC must be a leading participant and enabler of customer-centered longitudinal care planning and coordination across providers and contexts.
Quality: LTPAC must leverage technology to support transparent, accountable delivery, measurement, and improvement of quality of care, services and outcomes as experienced by consumers both within and across care settings.
Business Imperative: LTPAC must leverage technology to generate innovative, efficient business and service strategies and models that will assure it a leading role in the future of health and wellness delivery.
Consumer-Centered: LTPAC’s unique opportunity lies in its ability to leverage technology to build on its legacy of longitudinal person-centered care and services through effective integration of care and hospitality paradigms.
Workforce Acceleration: LTPAC must re-equip, re-empower, and re-educate its workforce to effectively leverage technologies as part of care and hospitality service delivery to create great customer relationships, experiences, and outcomes.
Work with stakeholders at national, state and local levels to identify and advocate for opportunities to include LTPAC in health IT and innovation initiatives, such as Meaningful Use.
Invest in emerging technologies, business models and workforce skill sets that support significant improvements in workflow automation, decision support, HIE, user productivity and consumer engagement.”
“This report examines eleven emerging technologies that have the potential to improve care and lower costs for chronic disease patients.
The full report gives an in-depth analysis of the clinical and financial benefits of each of the eleven technologies and offers an overview of the barriers that hold back their adoption. The eleven emerging technologies that offer new ways to monitor and manage chronic illnesses are:
Extended Care eVisits
Medication Adherence Tools
Mobile Asthma Management Tools
Mobile Cardiovascular Tools
Mobile Clinical Decision Support
Mobile Diabetes Management Tools
Social Media Promoting Health
Care at Home: Older people’s experiences of domiciliary care – Patient and Client Council [Ireland] – June 2012
Extract from the executive summary
“The purpose of this report is to record the experiences of older people receiving a domiciliary care service as well as the views of carers. The report provides a timely illustration of older people’s perspectives on domiciliary care, within the context of the review of health and social care currently being undertaken in Northern Ireland and the existing debate around care provision for a rapidly ageing population.
A total of 1161 people took part in this process; 700 people completed a questionnaire outlining their experiences of receiving domiciliary care, 38 people in receipt of an intensive home care service took part in an interview, 170 people participated in small discussion groups and 253 members of the public filled out a short questionnaire.
Through this combined approach of quantitative and qualitative methods, including one-to-one interviews with older people and their carers, this report expands on themes indentified by service users in previous surveys, as well as providing fresh insight into home care services and a deeper understanding of older people’s experience of domiciliary care.”
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Measuring Health System Progress in Reducing Mortality from Noncommunicable Diseases – RAND – May 2012
by Soeren Mattke, Jack C. Chow
“Noncommunicable diseases (NCDs) place a heavy burden on developing countries, whose relatively recent adoption of Western-style health behaviors and lifestyle choices has led to increased prevalence of risk factors for NCDs over the past decade. NCDs are compounding the burden of infectious disease on health systems in those countries. In response, the World Health Organization (WHO) has launched several risk reduction initiatives. WHO is drafting a monitoring framework and voluntary targets as the basis for a consultation process with member states. However, the indicators and targets that a global consultation process will produce will inevitably provide high-level, aggregated information, such as progress toward reducing premature NCD mortality. Regional and national decisionmakers and planners, on the other hand, will need more proximal and granular information to track progress toward high-level goals and will be constrained by the resources and demands in their respective jurisdictions. The relative importance of different risk factors and manifest NCDs differs across countries, and so do health systems’ capabilities and resources. Thus, national and regional decisionmakers will need: (1) a comprehensive set of indicators to guide on-the-ground prioritization decisions and track progress toward high-level targets and (2) actionable data to predict the impact of changes in proximal indicators on high-level targets. As a first step, this occasional paper outlines a roadmap toward a comprehensive system for national and regional decisionmakers to (1) track progress toward the key WHO goal of reducing NCD mortality by 25 percent by 2025 and (2) prioritize resources and interventions to achieve that goal.”Read Full Post | Make a Comment ( Comments Off on Measuring Health System Progress in Reducing Mortality from Noncommunicable Diseases – RAND – May 2012 )
Long Term Conditions Compendium 3rd ed [UK] – 30 May 2012
“The Department of Health has published the third edition of the Long Term Conditions Compendium of Information. It is aimed at commissioners as well as health and social care professionals, to provide the evidence for improving care and outcomes for people with long term conditions (LTCs). It updates the second edition of the compendium published in January 2008.
This document contains the latest statistical data on long term conditions, links to the LTC QIPP (quality, innovation, productivity and prevention) workstream and provides data from the ongoing evaluation of the Whole System Demonstrator Programme on telehealth and telecare, which supports the delivery of 3 Million Lives. It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.
The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.”Read Full Post | Make a Comment ( Comments Off on Long Term Conditions Compendium 3rd ed [UK] – 30 May 2012 )
Improving Health Outcomes: The Role of Food in Addressing Chronic Diseases – The Conference Board of Canada – May 2012
“Improving Health Outcomes gives an overview of the issues, challenges, and potential solutions for improving dietary risk management. It examines the relationship between food, health, and chronic diseases.
This report examines the relationship between food, health, and chronic diseases—a key consideration for the Canadian Food Strategy being developed by The Conference Board of Canada’s Centre for Food in Canada (CFIC). The report considers the food-related risk factors for three highly prevalent chronic diseases—cardiovascular disease, cancer, and diabetes. It examines current and historical dietary patterns to assess Canadians’ food-related risks; assesses how well consumers, industry, and governments are managing the key dietary risks; and considers the effectiveness of interventions to encourage healthy eating. The report concludes by proposing seven potential measures that consumers, government, and industry can take to improve dietary risk management to cut the burden of chronic diseases.”Read Full Post | Make a Comment ( Comments Off on Improving Health Outcomes: The Role of Food in Addressing Chronic Diseases – The Conference Board of Canada – May 2012 )
World Health Statistics 2012 – WHO – May 2012
“World Health Statistics 2012 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.
This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage.”Read Full Post | Make a Comment ( Comments Off on World Health Statistics 2012 – WHO – May 2012 )
A Life More Ordinary: findings from the Long-Term Neurological Conditions Research Initiative [UK] published – 22 May 2012
A Life More Ordinary: findings from the Long-Term Neurological Conditions Research Initiative [UK] published – 22 May 2012
“A Life More Ordinary ‘provides a summary of the main findings from the Long-term Neurological Conditions Research Initiative (LTNC RI). The Initiative was funded by the Department of Health’s Policy Research Programme (DH PRP) in 2006, following the launch of the DH National Service Framework (NSF) in 2005.’ (Winchcombe 2012 p9).
The objectives of the initiative were to provide a baseline against which to assess progress on the objectives of the National Service Framework for Long Term Conditions, to determine the extent of met and unmet need, and to evaluate the impact of new initiatives, including the NSF itself. The report gives the main findings from all the studies and discusses the implications for policy and practice.”
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Extract from the executive summary:
“Long term conditions coupled with depression are a significant and growing challenge for health and social care services. Between 15.4 to 17 million people have long term conditions. People with long term conditions are twice to three times more likely to experience depression and estimates suggest that 20% of people with long term conditions have depression.
The prognosis for people with long term conditions and depression is poorer care, poorer outcomes, a poorer quality of life and a substantial cost to the NHS; £8 to 13 billion is said to be the cost of care for those with long term conditions and mental health conditions in England1, with depression being the most common mental health problem. Studies indicate that depression can increase healthcare costs by 33% to 169% over a range of long term conditions.
Importantly also, depression can increase the risk of death for people with some long term conditions such as heart disease and cancer. A study has suggested a possible association between depression and cancer deaths. Additionally, it is estimated that the UK economy stands to lose £16 billion over the next 10 years through premature deaths due to heart disease, stroke and diabetes”
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Self-management support for Canadians with chronic health conditions: A focus for primary health care – Health Council of Canada – May 2012
“The report explores how self-management support can improve patient outcomes and better integrate the health system for this purpose. It profiles a range of practices and calls for targeted investments in self-management support strategies.”Read Full Post | Make a Comment ( Comments Off on Self-management support for Canadians with chronic health conditions: A focus for primary health care – Health Council of Canada – May 2012 )
Summary of the Evidence on Performance of the Patient Activation Measure (PAM) – NHS Kidney Care – May 2012
Extract from the Background:
“What is Patient Activation?
Patient Activation refers to people’s ability and willingness to take on the role of managing their health and health care. The concept of activation focuses on skills and knowledge required for day-to-day management of one’s own health. Positive changes in patient activation can lead to positive self-management behaviour changes in patients with chronic conditions.
Patient activation interventions have been developed for patients with cancer, diabetes, hypertension, obstetrical and gynaecological issues, and end-stage renal disease. Such interventions work to increase patient involvement in personal healthcare through education and skill-building, often targeted toward patients initiating specific conversations with their clinicians, thereby promoting a bidirectional interaction between clinicians and patients.”
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World health statistics 2012 report – WHO – 16 May 2012
“The World health statistics 2012 report, released today, puts the spotlight on the growing problem of the noncommunicable diseases burden.
One in three adults worldwide, according to the report, has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease. One in 10 adults has diabetes.
“This report is further evidence of the dramatic increase in the conditions that trigger heart disease and other chronic illnesses, particularly in low- and middle-income countries,” says Dr Margaret Chan, Director-General of WHO. “In some African countries, as much as half the adult population has high blood pressure.”
For the first time, the World Health Organization’s annual statistics report includes information from 194 countries on the percentage of men and women with raised blood pressure and blood glucose levels.”
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Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality – The Commonwealth Fund – 16 May 2012
M. B. Rosenthal, M. K. Abrams, A. Bitton, and the Patient-Centered Medical Home Evaluators’ Collaborative, Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality, The Commonwealth Fund, May 2012.
The patient-centered medical home has emerged as a promising solution to address the significant fragmentation, poor quality, and high costs that afflict the U.S. health care system. The medical home model includes core components of primary and patient-centered care, recent innovations in practice redesign and health information technology, and changes to the way practices and providers are paid. There are initiatives across the country testing the promise of the medical home model. However, to properly evaluate and compare results that will aid in the implementation of these and other initiatives, researchers need a standard set of core measures. This brief describes the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate the patient-centered medical home. It focuses on two domains of medical home outcomes: cost/utilization and clinical quality.”
“A new action plan for treatment of respiratory problems is set out in guidance published today for the NHS.
Some 45 best practice actions are outlined for the treatment of Chronic Obstructive Pulmonary Disease (COPD) and asthma. The two can be confused due to similar symptoms and understanding the similarities and differences will help doctors provide better treatment. A key part of the new strategy is reducing the variation in COPD diagnosis and care around the country.
COPD kills around 23,000 people per year, and if the new guidelines are followed across the NHS then an estimated 7,800 lives could be saved annually. The NHS currently spends £1bn a year on COPD. It costs nearly ten times more to treat severe COPD than the mild disease, so improved diagnosis rates could deliver significant cost savings too.”
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Co-creating Health: Evaluation of first phase – The Health Foundation [UK] – April 2012
An independent evaluation of the Health Foundation’s Co-creating Health improvement programme
“This report gives the findings from an independent evaluation of phase 1 of our Co-creating Health self-management support improvement programme.
The first phase of Co-Creating Health began in 2007. It was a three year initiative in eight sites across the UK that aimed to demonstrate the impact, on clinicians and patients alike, of integrating self-management support into routine care for people with long-term conditions.
The evaluation of the programme provides valuable insights into what worked and the further challenges health systems need to address to support people to develop confidence in managing their long-term conditions themselves.
Some of the key findings from the evaluation were:”
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The Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients – The Commonwealth Fund – 26 April 2012
The Commonwealth Fund Commission on a High Performance Health System
The Commonwealth Fund Commission on a High Performance Health System believes the federal government needs a comprehensive implementation plan to take full advantage of the opportunities in recent health reform legislation. Such a plan requires a vision and clear goals for performance improvement, collaboratively determined priorities, simplified administrative requirements, and rapid data-driven feedback. By 2016, the nation should seek to double annual improvement in quality-of-care metrics and to hold the per capita increase in health expenditures to the annual growth in per capita GDP, plus 0.5 percentage points—reducing national expenditures by $893 billion over 10 years. To help achieve these goals, the Commission proposes the U.S. create 50 to 100 voluntary “Health Improvement Communities” focused on patients with multiple, high-cost chronic conditions. Through payment reform, enhanced primary care, and health information technology, this effort could yield $184 billion in savings, or 21 percent of the overall target.”Read Full Post | Make a Comment ( Comments Off on The Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients – The Commonwealth Fund – 26 April 2012 )
by David Squires
“High-quality care for patients with chronic and complex conditions often involves coordinating between multiple providers and sources of care. Fee-for-service payment, which reimburses providers for a particular service, fails to provide incentives to coordinate care and can encourage providers to work in silos. Bundled payments—also known as episode-based payment or case rates—have been proposed as a way to encourage coordination across providers and to promote more efficient care. Under a bundled payment, a single fee is paid for an entire episode of care; for example, a single fee for hip replacement would cover both the procedure itself and the rehabilitation and follow-up treatments. This fee would be divided among the providers along the care pathway, either prospectively or retroactively.
Bundled payments already exist in the U.S. in a number of systems, such as the Geisinger Health System. The Affordable Care Act contains provisions advancing bundled payments in Medicare, including a large-scale pilot scheduled to be rolled out by January 1, 2013. Other countries have also experimented with bundled payments, most notably the Netherlands and Germany. Their experiences can inform U.S. efforts to reform health system payment and drive improvement.”
… continues on the site
Bundling Payments for Chronic Conditions in the Netherlands
Integrated Care Contracts in Germany
Funding and performance on clinical guidelines. The cases of dementia and chronic obstructive pulmonary disease – RAND – April 2012
by Emmanuel Hassan, Helen Ridsdale, Jonathan Grant, Susan Guthrie
“In September 2009, the United Kingdom (UK) Medical Research Council, the Wellcome Trust and the Department of Health (England) commissioned RAND Europe to investigate the characteristics of research cited in two UK clinical guidelines: Dementia and Chronic Obstructive Pulmonary Disease (COPD).
The exploratory work is part of an overall drive among funders to understand better how research reaches policy and practice.
The objectives of our exploratory study were to understand the following questions.
What are the characteristics of publications cited in these clinical guidelines?
On those papers with a UK affiliation, who funded the research cited in these clinical guidelines?
This report presents the findings of our work, based on the two guidelines.”Read Full Post | Make a Comment ( Comments Off on Funding and performance on clinical guidelines. The cases of dementia and chronic obstructive pulmonary disease – RAND – April 2012 )
Long-term health gains: Investing in emotional and psychological wellbeing for patients with long-term conditions and medically unexplained symptoms – NHS Confederation – 18 April 2012
“A close relationship exists between long-term physical conditions and mental health and wellbeing. Long-term physical conditions often affect a patient’s mental health, and psychological wellbeing can also have an impact on the effectiveness of treatment for, and a patient’s ability to manage, long-term conditions. Despite this, many individuals do not receive care that addresses both their physical and psychological needs.
There is a growing body of clinical and economic evidence supporting investment in psychological services as part of the treatment for long-term conditions – people with long-term conditions use disproportionately more primary and secondary care services and are more likely to develop depression than the rest of the population.
A new Mental Health Network report, ‘Investing in emotional and psychological wellbeing for patients with long-term conditions’, brings together the evidence across diabetes, chronic obstructive pulmonary disease and coronary heart disease, plus medically unexplained symptoms, to present a business case for investing in psychological services.
This Briefing summarises the report and describes how primary and secondary health services can improve patient outcomes, while reducing the overall costs of care for the NHS reducing the overall costs of care for the NHS.”Read Full Post | Make a Comment ( Comments Off on Long-term health gains: Investing in emotional and psychological wellbeing for patients with long-term conditions and medically unexplained symptoms – NHS Confederation – 18 April 2012 )
Investing in emotional and psychological wellbeing for patients with long-term conditions – NHS Confederation – 18 April 2012
“A guide to service design and productivity improvement for commissioners, clinicians and managers in primary care, secondary care and mental health.
For many patients, several physical illnesses will coexist at any one time, and for some a mental health disorder will also be present. In the face of such multi-morbidity and need, focus on the patient journey across the lifespan and across the care system will maximise effective service design and delivery.
The collation of evidence and emerging economic analysis, together with examples of service design and delivery in this guide, will assist commissioners, clinicians and managers in primary care, secondary care and mental health in designing services, improving productivity and learning across disease-specific groups.”Read Full Post | Make a Comment ( Comments Off on Investing in emotional and psychological wellbeing for patients with long-term conditions – NHS Confederation – 18 April 2012 )
by Ellen Nolte et al
“The report forms part of the DISMEVAL project, funded under the European Commission’s 7th Framework Programme. It is targeted at policymakers, programme operators and researchers, explaining choices, options and trade-offs for the evaluation of disease management based on analyses undertaken within the project. Many of the issues discussed can be seen to apply to any evaluation of complex interventions in healthcare. However, there are specific concerns around evaluation design and metrics that are of relevance to the evaluation of disease management in particular and that are examined in the report. These include (i) the context for evaluating disease management, exploring the reasons for undertaking evaluation in the first place and explaining some of the underlying principles for doing so; (ii) the methods and metrics for evaluating disease management, focusing specifically on themes that have emerged as being pertinent to work carried out within the DISMEVAL project; (iii) practical considerations for disease management evaluation, based on experience of work undertaken in DISMEVAL; and (v) the broader challenges and lessons learned that may be relevant for policymakers, funders and practitioners interested in the use and usefulness of disease management evaluation more generally. This publication provides a major resource to guide the evaluation of disease management interventions in European settings and so contributes to strengthening the evidence-base required to inform the selection of efficient and effective interventions to address the growing burden of chronic disease in Europe.”Read Full Post | Make a Comment ( Comments Off on Evaluating chronic disease management. Recommendations for funders and users – RAND – April 2012 )
DISMEVAL Developing and validating disease management evaluation methods for European healthcare systems. Final report – RAND – April 2012
Edited by Ellen Nolte, Saba Hinrichs
“The report documents the overall findings of the work carried out within the DISMEVAL project which was funded under the European Commission’s 7th Framework Programme. It sought to review current approaches to chronic care and their evaluations, as implemented by EU Member States at national and regional levels and to explore the policy context for chronic disease management in European countries. Reporting on the range of approaches to chronic care adopted in 13 European countries it emphasises the need for the development of a coherent response to chronic disease that takes account of the various tiers in the system and along the care continuum, with involvement of professionals forming a crucial component for achieving sustainable change. The DISMEVAL project further sought to test and validate different evaluation methods using existing data from disease management interventions in six countries. In doing so, it advances the research base in evaluation design and methodology, so informing the design of future evaluations and enhancing their value for decisionmaking. Work carried out identified and tested a wide range of methods that can be employed in situations where experimental approaches are not possible, emphasising that rigorous evaluation is still possible where baseline or predefined control groups are not available and how advanced designs can help better understand how different (combinations of) care components and processes might be effective for managing chronic disease in patients with different characteristics. It argues how future evaluation work drawing on such approaches should provide insight into what works for whom in the area of disease management, a question that randomised trials have thus far been unable to answer.”Read Full Post | Make a Comment ( Comments Off on DISMEVAL Developing and validating disease management evaluation methods for European healthcare systems. Final report – RAND – April 2012 )
Data briefing: Emergency hospital admissions for ambulatory care-sensitive conditions. Identifying the potential for reductions – King’s Fund – 3 April 2012
Ambulatory care-sensitive conditions (ACSCs) are conditions for which effective management and treatment should limit emergency admission to hospital. Nevertheless, ACSCs currently account for more than one in six emergency hospital admissions in England. These emergency admissions cost the NHS £1.42 billion each year.
High levels of admissions for ACSCs often indicate poor co-ordination between the different elements of the health care system, in particular between primary and secondary care. An emergency admission for an ACSC is a sign of the poor overall quality of care, even if the ACSC episode itself is managed well.
This data briefing considers patterns of admissions for ACSCs in terms of age, sex, condition, socioeconomic group and local authority area. The authors analyse these patterns and assess the potential for reducing emergency admissions for ACSCs, highlighting the disease areas and patient groups where the greatest reduction can be achieved.
The briefing concludes that the number of emergency hospital admissions for ACSCs could be reduced by:
18 per cent (potentially saving £238 million) if all local authorities performed at the level of the best-performing local authorities
8 per cent (potentially saving £96 million) if each local authority improved their service to the level of the next best local authorities
11 per cent (potentially saving £136 million) if the poorer (than the average) performing local authorities performed at the level of the better (than the average) ones.
This briefing highlights for commissioners the opportunities for improving the quality of care and saving costs that reducing emergency hospital admissions for ACSCs presents. To realise the potential savings, changes will be needed in the management and prevention of these conditions.”Read Full Post | Make a Comment ( Comments Off on Data briefing: Emergency hospital admissions for ambulatory care-sensitive conditions. Identifying the potential for reductions – King’s Fund – 3 April 2012 )
Country-Level Decision Making for Control of Chronic Diseases – Workshop Summary – Institute of Medicine – 2 April 2012
“A 2010 IOM report, Promoting Cardiovascular Health in the Developing World, found that not only is it possible to reduce the burden of cardiovascular disease and related chronic diseases in developing countries, but also that such a reduction will be critical to achieving global health and development goals. One key step to achieving this outcome is to identify practical ways to assist low- and middle-income countries in improving control of chronic diseases through the approaches that are led by a country’s decision makers and stakeholders and that will be most appropriate, effective, and feasible based on a country’s circumstances.
As part a series of follow-up activities to the 2010 report, the IOM planned a workshop to explore ideas and opportunities for supporting country-specific assessment of resource needs and planning of resource allocation for chronic diseases as part of the broader process of priority setting, decision making, and planning. The workshop, held in July 2011, aimed to identify what is needed to create tools for country-led planning of effective, efficient, and equitable provision of programs to prevent and reduce the burden of chronic diseases. This document summarizes the workshop.”Read Full Post | Make a Comment ( Comments Off on Country-Level Decision Making for Control of Chronic Diseases – Workshop Summary – Institute of Medicine – 2 April 2012 )
Risk factors contributing to chronic disease – AIHW – 29 March 2012
“Chronic diseases are responsible for a large portion of the disease burden in Australia, and many are highly preventable by reducing known risk factors. This report shows that: ~Most people have at least one risk factor and more than 90% do not consume enough vegetables. ~Social disadvantage is associated with risky health behaviours. ~Nearly 60%of Australians do not undertake sufficient levels of physical activity, and many of us (almost 80%) usually spend 3 or more hours sitting during our leisure time.”
ISBN 978-1-74249-283-4; Cat. no. PHE 157; 124ppRead Full Post | Make a Comment ( Comments Off on Risk factors contributing to chronic disease – AIHW – 29 March 2012 )
Canada, Australia and New Zealand establish a new research partnership – Australian Health Workforce Institute – 20 March 2012
“Ottawa (March 20, 2012) – The Canadian Institutes of Health Research (CIHR), the Australian Primary Health Care Research Institute (APHCRI) at the Australian National University and the Health Research Council of New Zealand (HRC NZ) are partnering to fund research on innovative models of Community-based Primary Healthcare (CBPHC). As part of CIHR’s Signature Initiative, funded teams will examine how to better prevent and manage chronic disease, as well as improve access to care for vulnerable populations.”
Read more:http://www.cihr-irsc.gc.ca/e/45078.htmlRead Full Post | Make a Comment ( Comments Off on Canada, Australia and New Zealand establish a new research partnership – Australian Health Workforce Institute – 20 March 2012 )
Taking action to prevent chronic disease: recommendations for a healthier Ontario – Cancer Care Ontario, Public Health Ontario – 2012
Published by the Ontario Agency for Health Protection and Promotion, and Cancer Care Ontario (Public Health Ontario)
ISBN 978-1-4435-8969-7 Print
ISBN 978-1-4435-8970-3 PDF
“In the first of our Future Care series, Care and technology in the 21st century explores the current landscape on care and technology and calls for a technological transformation in the way we support families caring for ill, frail and disabled loved ones.
The report argues that the way families already use technology to work, plan their lives, shop and socialize should also be reflected in how we care and calls on the Government to set up a new independent, expert taskforce to drive innovation and partnership on care technology.”Read Full Post | Make a Comment ( Comments Off on Future care: Care and technology in the 21st century – Carers UK – March 2012 )
COPD Online, an interactive training program for primary care nurses – Australian Lung Foundation – 22 March 2012
“In an Australian first, primary care nurses now have access to Chronic Obstructive Pulmonary Disease (COPD) training, regardless of where they live. COPD Online is a new web-based interactive training program developed by The Australian Lung Foundation (Lung Foundation) especially for primary care nurses which teaches participants about COPD, how to identify and manage patients with COPD, and develop self-management plans with patients.
COPD Online has been 18 months in the making and The Lung Foundation’s Director of the COPD National Program, Heather Allan, said the training was developed for a number of reasons. “Primary care nurses have a pivotal role in driving disease management programs at general practice. Until now, there was very little training to support that important role. This unique ten module intensive program will support the nurse’s role in identification, diagnosis and evidence based management of their patients with COPD,” Mrs Allan said.”
COPD Online is available on The Australian Lung Foundation’s website for $250.Read Full Post | Make a Comment ( Comments Off on COPD Online, an interactive training program for primary care nurses – Australian Lung Foundation – 22 March 2012 )
Diabetes: the silent pandemic and its impact on Australia – Baker IDI Health and Diabetes Institute, Diabetes Australia, Juvenile Diabetes Research Foundation – March 2012Read Full Post | Make a Comment ( Comments Off on Diabetes: the silent pandemic and its impact on Australia – Baker IDI Health and Diabetes Institute, Diabetes Australia, Juvenile Diabetes Research Foundation – March 2012 )
“Our online prezi presentation sheds light on the impact telehealth can have (positive or negative) on the management of people with long-term conditions.
To find out more about how we carried out the study and what our results show, read our review of the evidence.”Read Full Post | Make a Comment ( Comments Off on What impact does telehealth have on long-term conditions management? – King’s Fund – 15 March 2012 )
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