Working Harder, Spending Smarter, and Doing the Right Thing
Posted Sep 22 2008 10:57pm
We need leadership that is focused to a much greater degree on Chronic Disease Management. Effective chronic disease management greatly reduces health care costs and helps people live healthier, happier, more independent lives.
If you saw somebody struggling day after day with a debilitating chronic illness and had in your power a way to help that person live a fuller, healthier life, you'd offer the needed help without hesitation, wouldn't you? Sure you would! But when it comes to providing funding for programs that educate and support those who have chronic disease, our government falls far short.
People these days are living longer with chronic disease and they are spending more years in the health care system, consquently putting a greater economic strain on that system. In her book, The Chronic Illness Experience, Cheri Register says, "No longer illnesses to die of, but still not thoroughly curable, they have become illnesses to live with."
With proper chronic disease management, patients learn to take care of their health, empowered to remain as stable as possible, independent and at home, with as few visits to the emergency room and in-patient hospital stays as possible.
On the other hand, when a chronic disease is not well managed, patients are more likely to develop crisis episodes, or acute exacerbations, requiring expensive emergency and in-patient care. For those working in healthcare, this is referred to as the revolving door. Patients come into the hospital in a crisis, and they are very ill. They are given excellent care and become well enough to return home. They return home, however, with little or no instruction on how to prevent another episode, only to fall ill again and return to the hospital with the same problem for more of the same expensive treatment. Unfortunately, this method of care, such that it is, is the status quo. Can we do better? Yes, we can. And we actually do, but we do it on a relatively small scale with little or no support from the government or Medicaire.
Let's talk for a moment about two major chronic illnesses that cost our health care system, and us as taxpayers, a lot of money when not effectively managed, and save a lot of money when they are! These are COPD (Chronic Obstructive Pulmonary Disease which is an umbrella term for emphysema and chronic bronchitis, sometimes with a component of asthma) and CHF (Congestive Heart Failure, or sometimes called Heart Failure). Both of these disorders, when poorly managed, can require severe, acute illness, overnight hospital stays - commonly several within one year. But with proper education and support, people with COPD or CHF can lead full, relatively healthy and independent lives, greatly reducing high utilization and costs.
There are programs out there that are working. In spite of an abysmal lack of funding, many organizations already have programs in place. Imagine what could be done if programs were funded. More organizations would have programs with patients involved in learning how to gain the strength, knowledge, and confidence to help themselves effectively manage their chronic illness at home and prevent expensive hospitalizations. Sound idealistic? Those of us working in the trenches know it is not. It is real and it works!
Two such types of programs are Pulmonary Rehabilitation for COPD and the Specialized Heart Failure Clinic for CHF. There are studies showing that patients with chronic disorders who participate in out-patient programs of education and support are better able to manage their disease at home, staying out of the hospital, and thereby decreasing healthcare utilization and costs.
Pulmonary Rehabilitation is a program of exercise, education and support run by respiratory therapists, physical therapists and nurses, designed to return patients to their highest possible functional capacity to keep them in stable health without acute illness. Pulmonary Rehabilitation has been proven to decrease utilization and health care costs. See the study for further information.
Currently there is no Medicaire coverage for Pulmonary Rehabilitation, discouraging the development and expansion of programs.
In the Specialized Heart Failure Clinic patients learn not just the importance of avoiding excess salt intake, but are taught how to avoid it, as well as how to monitor their fluid status and weight. They meet with a nurse or receive regular phone follow-up phone calls. One study demonstrated that care at a program such as this can lead to significant reductions in patient morbidity, as measured by fewer hospital admissions, shorter hospital stays and improved quality of life. See this study for further information.
Neither of these types of programs are routinely covered by Medicaire and they certainly should be. Medicaire coverage across the board would encourage more facilities to open programs. This is definitely not a hand out. It is paying for a service that has been proven as a highly cost-effective way to empower patients with the information and support they need to lead healthier lives. It is simply - working harder, spending smarter, and doing the right thing.
The status quo, the revolving door, ignoring education and support in exchange for allowing further decline and sky-high inpatient care must stop.
People with chronic disease have the right, and the responsibility, to understand what they can do to manage their disease effectively and stay healthy at home and out of the hospital when at all possible.
Health care providers have the responsibility to develop and carry out programs that result in a more healthy, stable, independent life for the patient.
Elected leaders have the responsibility, when presented with the information, to do what they must to make these programs accessible and affordable to all, while being good stewards of the funds with which they are trusted.
So, we return to our initial question. If you saw somebody struggling day after day with a debilitating chronic illness and had in your power a way to help that person live a fuller, healthier life, you'd step up and help, wouldn't you? We should expect the same of our candidates. Shouldn't they join us in working harder, spending smarter, and doing the right thing?