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The Fat Lady, Attending a House of Worship, Disease Management Engagement Rates and the Little Things That Count

Posted Apr 12 2009 11:53pm
The Fat Lady reminds the Disease Management Care Blog that everyone should regularly attend a house of worship. Aside from matters of faith, it’s a good way to regularly put things into perspective while taking a break from worrying about tomorrow’s meetings and deadlines. More importantly, you’ll gain insights about the human condition that are generally ignored by popular culture. Heavy stuff indeed.

Presidents are a good illustration of this. Both Kennedy and Reagan, for example, reached for inspiration from the shining city upon a hill. Abraham Lincoln famously pointed out a house divided against itself cannot stand. Even President Obama has told us it is time to set aside childish things.

Well, the DMCB isn’t immune either. It reached into the Easter Service grab-bag for two insights about its little corner of healthcare.

First off, purchasers of disease management programs have long gnashed their teeth over low contact and engagement levels of all persons in their eligible populations. In its business dealings, the DMCB has tried to point out that increasing recruitment drives up costs, enrolls progressively more disinterested patients and counter-intuitively reduces the return on investment. Perhaps it should also point out that that it was recognized long ago that a message far more important than A1c levels, asthma medication compliance or blood pressure control has also been stymied by ears that do not hear. 100% of all eligible patients will never cooperate with disease management, engage with their patient-centered-medical-home team, log onto their electronic health record, buy health care insurance, take their medicines or see a physician. Since less than 100% engagement was described in important literature well over 2000 years ago, the population-base care industry should work on describing what engagement rates are possible, not ideal.

Secondly, the Gospel of John has an interesting detail about the Tomb and the Resurrection:

“and a linen, that was about his head, not lying with the linen clothes, but wrapped together in a place by itself.”

The DMCB isn’t too sure about the significance of the folded cloth separate from the rest of the rumpled burial linens. It was told by a Methodist preacher that the ancient carpenters used this to signal that their job was done. Even if that is not true, the Fat Lady still likes the special touch in this behemoth of a population-based (and soul saving) intervention. The lesson here is that the little things nurse coaches do to inspire, nudge and motivate their patients are as important as any exquisitely constructed, decision-supported, evidence-based protocol. While we think about populations and billions of dollars we’re preparing to spend on chronic illness, we need to remember that the small details also count in ways measured and unknowable.
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