Living Well with Chronic Illness A Call for Public Health Action (2012) / Chapter Skim
Currently Skimming:
5 Surveillance and Assessment
5 Surveillance and Assessment
Pages 187-228
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 187... ...
The results of these surveillance activities have been used to guide research investments and subsequent public health and health care interventions to address the major causes of mortality, including cardiovascular diseases and cancer; the associated chronic diseases, including obesity, hypertension, and hyperlipidemia; and behavioral risk factors, including poor diet, physical inactivity, and smoking. Life expectancy has improved over the past century, primarily as a result of public health interventions, such as tobacco control efforts, that have reduced the risk of the leading chronic diseases, such as heart disease, stroke, and cancer (Remington and Brownson, 2011)
|
From page 188... ...
and longer survival among patients diagnosed with chronic illness. Moreover, the rising costs of health care, along with evidence from research focused on patterns of health care utilization and costs, have focused attention on the societal burden of chronic diseases, particularly multiple chronic conditions (MCCs)
|
From page 189... ...
Because of the public health emphasis on health promotion and disease prevention (especially primary and secondary prevention) , chronic disease surveillance has traditionally focused on major risk factors for disease and the occurrence of chronic diseases.
|
From page 190... ...
Surveillance of chronic diseases may also be used to monitor progress in achieving the triple aim of health care improvement: that is, to improve the patient experience, to control costs, and to improve the health of the population (Institute for Healthcare Improvement, [a]
|
From page 191... ...
must be measured • Measurement instruments must be standardized to provide reli ability and comparability • Measurement instruments must be sensitive to change • Measurements must be ongoing and sustained In addition to the measurement of health status or outcomes at the individual level, comprehensive surveillance must incorporate measures of characteristics, exposures, and processes that affect health outcomes comprising the multiple determinants of living well and their interactions at the levels of the individual, the family, and the community; health care–related interventions; and public policy. Individual health-related behaviors, including lifestyle (e.g., smoking, physical activity, diet)
|
From page 192... ...
health worker flu laws and taxes sweetened beverages vaccination levels) Health care access, Insurance coverage, Self-report (e.g., ACOVE Claims data, hospital MEPS, HCAHPS coordination, quality, immunizations, cancer RAND)
|
From page 193... ...
, research NOTE: ACOVE RAND = Assessing Care of Vulnerable Elders -- A RAND Health Project; ADLs = activities of daily living; BRFSS = Behavioral Risk Factor Surveillance System; CPS = Current Population Survey; EPA = Environmental Protection Agency; HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; JCAHO = Joint Commission on Accreditation of Healthcare Organizations; MEPS = Medical Expenditure Panel Survey; NHANES = National Health and Nutrition Examination Survey; NHIS = National Health Interview Survey; PHQ-9 = Patient Health Questionnaire-9; RHIO = Regional Health Information Organization; SEER = Surveillance, Epidemiology, and End Results.
|
From page 194... ...
USE OF SURVEILLANCE TO INFORM PUBLIC POLICY DECISIONS Public health surveillance systems may be used to inform public policy decisions to improve the prevention and control of chronic illnesses at the individual or population level. In this section, we review how surveillance (i.e., data collection and reporting)
|
From page 195... ...
Public health surveillance systems can also be used to identify disparities in all aspects of chronic disease prevention and control. Monitoring and reducing health disparities has been a central focus of the U.S.
|
From page 196... ...
Disease Cancer registries • ata are increasingly available D • ystems are expensive. S registriesb,c throughout the United States.
|
From page 197... ...
2010. Chronic disease surveillance.
|
From page 198... ...
, and measures of psychological distress. Although the Behavioral Risk Factor Surveillance System (BRFSS)
|
From page 199... ...
used in arthritis, have been shown to predict morbidity and mortality in some chronic diseases as effectively as labora
|
From page 200... ...
h health-related health status in patients with chronic airflow limitation. Western Ontario 24 items across 3 subscales that assess pain, stiffness and physical function in patients with hip and/or knee McMasters University osteoarthritis (OA)
|
From page 201... ...
1980. Measuring health status in arthritis.
|
From page 202... ...
. Performance-based measures of physical function are often measured for research purposes and in clinical settings; however, their use in population-based surveillance has been largely limited to cross-sectional surveys, such as the National Health and Nutrition Examination Survey (NHANES)
|
From page 203... ...
Health insurance status and health care utilization claims data are often used as measures to infer access to and quality of health care services. For example, examination of variations in hospitalization rates for selected chronic diseases, termed ambulatory care sensitive conditions (e.g., congestive heart failure, chronic
|
From page 204... ...
. Moreover, the electronic health record (EHR)
|
From page 205... ...
. Population-Based Data and Methods Population-based data and information about chronic diseases, including measures of living well, are available from a number of sources (Table 5-2)
|
From page 206... ...
Despite advances in public health surveillance and health information systems (e.g., electronic health records) , few communities have comprehensive surveillance systems to measure chronic diseases and related health risk factors and quality of life.
|
From page 207... ...
PUBLIC HEALTH SURVEILLANCE SYSTEM INTEGRATION One of the biggest weaknesses of the current surveillance systems for chronic illness is the lack of integration between information collected at the patient, health system, and population levels. Detailed information may be collected from patients about chronic diseases, risk factors, and quality of life, but it is rarely captured in comprehensive health system databases.
|
From page 208... ...
, who analyzed data from a national sample in excess of 340,000 noninstitutionalized adults using the BRFSS and found that even a single question rating life satisfaction, a surrogate for living well, was strongly associated with unhealthy lifestyles, decreased health status, disability, and chronic illness. However, this measure has not been used to assess interventions among patients with chronic illnesses.
|
From page 209... ...
Health care organizations have used health information systems to improve processes of care and to reduce costs. Most of these systems have focused on measuring quality of health care using process measures, but relatively few routinely incorporate measures of health outcomes.
|
From page 210... ...
. However, these activities have largely focused on improving safety and outcomes associated with acute care rather than improving longer-term outcomes for patients with chronic illnesses.
|
From page 211... ...
During the 1980s, CDC established surveillance systems to monitor trends in risk factors for chronic diseases among adults (Behavioral Risk Factor Surveillance System) and children (Youth Risk Behavior Surveillance System, or YRBSS)
|
From page 212... ...
. Summary Multidimensional surveillance of risk factors and health outcomes data at the patient, health organization, and population levels is essential for informing decisions on priorities and interventions to enhance living well with chronic illness at the level of patients, health organizations, and communities.
|
From page 213... ...
Although many environmental, social, and health care factors contribute to health outcomes for persons with chronic illnesses, the current health care reform initiatives at the federal level are largely targeting health care access and quality. In addition, these initiatives include a number of policies and programs intended to enhance surveillance for chronic disease and enhance coordination of care.
|
From page 214... ...
In subsequent sections, we review potential methods and data sources for future surveillance to enhance living well, and research needs to address current gaps in knowledge relevant to surveillance for chronic illnesses. The Use of Patient-Reported Outcomes in Surveillance Systems PRO measures are considered essential for monitoring outcomes and quality of life in individuals with chronic illness.
|
From page 215... ...
215 SURVEILLANCE AND ASSESSMENT TABLE 5-6 Available PROMIS Instruments Domain Bank Short Forms Emotional distress -- anger 29 8 Emotional distress -- anxiety 29 4, 6, 7, 8 Emotional distress -- depression 28 4, 6, 8a, 8b Applied cognition -- abilities 33 4, 6, 8 Applied cognition -- general concerns 34 4, 6, 8 Psychosocial illness impact -- positive 39 4, 8 Psychosocial illness impact -- negative 32 4, 8 Fatigue 95 4, 6, 7, 8 Pain -- behavior 39 7 Pain -- interference 41 4, 6a, 6b, 8 Pain intensity 3 Physical function 124 4, 6, 8, 10, 20 Mobility Upper extremity Physical function for samples with mobility aid users 114 12 Sleep disturbance 27 4, 6, 8a, 8b Sleep-related impairment 16 8 Sexual function: global satisfaction with sex life and 10 7 other subscales Satisfaction with participation in discretionary social 12 7 activities Satisfaction with participation in social roles 14 4, 6, 7, 8 Satisfaction with social roles and activities 44 4, 6, 8 Ability to participate in social roles and activities 35 4, 6, 8 Companionship 6 4, 6 Informational support 10 4, 6, 8 Emotional support 16 4, 6, 8 Instrumental support 11 4, 6, 8 Social isolation 14 4, 6, 8 Peer relationships Asthma impact Global health 10 SOURCE: PROMIS Assessment Center. Instruments Available for Use.
|
From page 216... ...
, like the Health Vault by Microsoft, may also eventually provide data for surveillance of living well with chronic illness. Such tools allow individuals to record and track their own health information online.
|
From page 217... ...
While the entire nation does not have access to electronic medical records at this time, there is still widespread availability of EMR covering large segments of the population. The use and availability of EMR will continue to expand, which supports the incremental approach to enhanced chronic disease surveillance.
|
From page 218... ...
Research on Measurement of Chronic Disease Although the need for surveillance is a well-established function of public health, surveillance of chronic illness to enhance living well is complex and presents a number of challenges that will require further investigation at the individual, health organization, and population levels. Moreover, the effectiveness of potential future methods and data sources for surveillance to drive improvement will need to be determined.
|
From page 219... ...
health care system is comparative effectiveness research (Conway and Clancy, 2009; Dougherty and Conway, 2008) ; although this research agenda is focused on health care interventions, chronic disease surveillance is the first step in the intervention process.
|
From page 220... ...
Surveillance is the first step in the change process to drive interventions to address gaps for patients with chronic illnesses to live well and to improve the nation's health and economic well-being by reducing disability and improving quality of life and functioning. This shift in focus from only extending life to living well has the potential to facilitate decision making at the individual, health care system, and population levels that optimizes outcomes not only for patients and families but also for society.
|
From page 221... ...
However, these interventions can produce short-term changes in behaviors and other risk factors. Information about chronic diseases should be collected on all persons.
|
From page 222... ...
Recommendation 17 The committee recommends that the secretary of HHS establish and support a standing national work group to oversee and coordinate multidimensional chronic diseases surveillance activity, including ob taining patient-level data on health-related quality of life and functional status from electronic medical records and data on the implementa tion and dissemination of effective chronic disease interventions at the health care system and the community level, including longitudinal health outcomes. REFERENCES Abrams, T.E., M
|
From page 223... ...
Preventing Chronic Disease 8(1)
|
From page 224... ...
2011. A National Surveillance System for Cardiovascular and Select Chronic Diseases.
|
From page 225... ...
Pre venting Chronic Disease 7(4)
|
From page 226... ...
2010. Chronic disease surveillance.
|
From page 227... ...
2004. Testing the functional status model in patients with chronic obstructive pulmonary disease.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.