Meeting The Challenge Of Chronic Illness

by Kane, Robert L.

• ISBN13: 9780801882098
• ISBN10: 0801882095
• Edition: 1st
• Format: Hardcover
• Copyright: 2005-11-01
• Publisher: JOHNS HOPKINS UNIV PRESS

Summary

Chronic conditions such as arthritis, heart disease, and Parkinson disease are the principal cause of all sickness and death in the United States and represent the vast majority of health care expenditures. Although we now live in a world dominated by chronic conditions, health care is still organized around a commitment to treating acute illnesses. Meeting the Challenge of Chronic Illness examines current deficiencies in chronic illness care and explores ways to improve it. Addressing the challenges of shifting from the primacy of acute illnesses to the predominance of chronic conditions, the authors identify the components necessary to reorganize and reform health care: properly prepared health care workers; involved patients and families; appropriate use of new technologies, especially information systems; an appropriate role for prevention; and the creation of funding approaches that will provide necessary incentives. This book calls on policy makers, health care providers, and educators to address one of the greatest challenges facing the health care system.

Author Biography

Robert L. Kane, M.D., is a professor and the Minnesota Chair in Long-Term Care and Aging at the University of Minnesota School of Public Health. Reinhard Priester, J.D., is a coordinator in the Division of Health Services Research and Policy of the University of Minnesota School of Public Health. Annette M. Totten, Ph.D. is director of the Center for the Study of Aging at Boise State University.

Table of Contents

Foreword	xi
Edward Wagner
Acknowledgments	xv
Introduction	xvii
Caring for People with Chronic Illness
What's So Special about Chronic Illness Care?	3	(20)
Acute and Chronic Conditions	7	(2)
Acute and Chronic Care	9	(1)
What Is Different about Chronic Illness Care?	10	(6)
Defining the Territory	16	(7)
The Dimensions of Chronic Illness	23	(21)
Who Are the Chronically III?	31	(3)
Impact of Chronic Conditions	34	(8)
Summary	42	(2)
How the Current System Fails People with Chronic Illnesses	44	(21)
Structure and Function	46	(8)
Personnel	54	(2)
Payment	56	(3)
Summary	59	(6)
Opportunities for Change
Reorganizing Care in the Face of Chronic Illness	65	(26)
Self-management	68	(3)
Interdisciplinary Team Care	71	(3)
Group Visits	74	(2)
Disease Management	76	(6)
Case Management	82	(6)
Geriatric Evaluation and Management	88	(1)
Summary	89	(2)
The Right Health Care Workers with the Right Skills	91	(29)
Workforce Supply and Demand	92	(6)
Chronic Care Skills and Competencies	98	(12)
Settings for Health Care Professional Education	110	(1)
Environmental Changes to Support Training	110	(1)
Changing Roles	111	(4)
Barriers	115	(3)
Summary	118	(2)
Patients and Families	120	(17)
Patient Involvement	121	(3)
Family Involvement	124	(5)
Challenges and Issues	129	(3)
Toward a Patient-Centered System	132	(1)
Summary	133	(4)
Innovative Technology	137	(27)
Information Technology	140	(12)
Patient Care Technology	152	(2)
Assistive and Environmental Technology	154	(2)
Barriers	156	(7)
Summary	163	(1)
Prevention	164	(19)
Preventing the Development of Chronic Disease	164	(10)
Preventing Decline and Disability	174	(2)
Promoting Health and Well-being in the Face of Serious Illness	176	(2)
Preventing Iatrogenic Complications	178	(1)
Medications and latrogenic Complications	178	(4)
Summary	182	(1)
Paying for Chronic Care	183	(16)
Paying Providers	185	(2)
Insurers versus Providers	187	(4)
The Provider's Perspective	191	(2)
Role of Managed Care	193	(3)
Summary	196	(3)
Prospects for Change
The Context for Reform	199	(13)
Public Sector Initiatives	200	(2)
Private Sector Initiatives	202	(1)
Chronic Care Reform: Missing in Action	203	(2)
Barriers to Reform	205	(5)
Necessary Steps	210	(2)
Next Steps	212	(27)
Report Card on IOM Recommendations	212	(4)
Models for Reform	216	(10)
Essential Issues for Chronic Care Reform	226	(13)
Appendix A. Why Journalists Struggle with the Chronic Illness Story	239	(13)
Appendix B. Lessons from the United Kingdom	252	(17)
Notes	269	(8)
References	277	(18)
Index	295

Excerpts

"This book views the issues from the perspectives of the patients and families and of professional caregivers and policy makers. Unlike many discussions of chronic illness care, it considers the entire spectrum of chronic illness, from fully functional individuals trying to control their illness and prevent complications to frail, older people in need of ongoing services. We have needed a thoughtful, comprehensive examination of the evidence and issues in caring for individuals and families with chronic illness. Now we have one."--From the foreword by Edward Wagner, M.D., M.P.H., Director, MacColl Institute for Healthcare Innovation, Seattle, Washington