DNP 810 Topic 7 Discussion Question One
DNP 810 Topic 7 Discussion Question One
What is the impact of chronic disease on both increased health care expenditures and wasted resources? Do genetics play a role? How can the doctoral-prepared nurse apply this information in practice? Explain. Support your rationale with a minimum of two scholarly sources.
Currently, some 50% of the US population has a chronic disease, creating an epidemic, and 86% of health care costs are attributable to chronic disease. The medical profession and its leadership did not recognize or respond appropriately to the rising prevalence of chronic disease. As a consequence, a health care crisis emerged, with inadequate access to care and quality of care together with
excessive costs. In the years since the 1950s, when the chronic disease prevalence grew, the clinical literature did not follow. It remained preoccupied with acute disease. Similarly, medical education did not change. Studies and critiques gave little or modest attention to the rising dominance of chronic disease and neglected elements of good care.
Recently, some health services responding to their growing number of patients with chronic illness have designed and tested new ways of providing care. They have found that, as a result, the patient’s health outcomes were improved, costs of care were lower, and patient satisfaction was higher. These results and experiences provide examples of what can be done. The health care crisis and the emergence of a chronic disease epidemic coincided to a substantial degree. Although the epidemic did not cause the crisis, it contributed significantly. Now, the medical profession and its leadership are confronted by the responsibility to build a practice of medicine and a health care system that better meet the needs of patients with chronic illness and reduces the health care crisis.
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Using combinations of these innovations, many of which were joined together in the Chronic Care Model of practice 21, 22, the organizations found that they not only improved the quality of care but also decreased costs. Improved quality arose from enhanced self‐care, fewer complications from disease or treatment, and greater satisfaction for patients and physicians. Lesser costs resulted from greater patient involvement in care, reduced emergency department visits, and fewer hospitalizations. For example, when Group Health Cooperative improved coordination of care, access to care, and goal setting with patients, several things happened: patient involvement increased, hospitalizations declined 6%, emergency department visits declined 29%, and costs diminished $10.3 per patient per month. When Intermountain Healthcare increased self‐care, it found improved outcomes for depression and diabetes and 10% fewer hospitalizations. The German Health Insurance Program compared results from using the Chronic Care Model for 10 000 patients with diabetes with results from an equal number of patients with diabetes receiving usual care over 4 years. The study group had 50% fewer deaths, 25% fewer disease complications, and 11% less costs.
These results were obtained mostly by primary care physicians (family physicians, internists, and pediatricians) who sought to improve their care and teach through practice and service modification. But the results are not just relevant to primary care. In various ways, they are pertinent to any physician or practice whose patients have a chronic illness.
Success of the practice innovations depends on behavior change by all involved, not on different uses of medicines or surgery. The physician becomes a partner of the patient who adjusts treatment to the patient’s health state and wishes. The patient, who must bear the consequences of the disease and treatment, becomes a caregiver and care team member, executing the treatment plan daily. A nonphysician team member maintains remote contact with the patient, facilitating the treatment plan. The health service assures support of the health team and needed changes in the treatment plans as they evolve. Such a practice pattern, similar to that proposed by Engel in 1977 23, will create a mood and logic of collegiality that is central to success with a chronic illness.