Living Well with Chronic Illness A Call for Public Health Action (2012) / Chapter Skim
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6 Interface of the Public Health System, the Health Care System, and the NonHealth Care Sector
6 Interface of the Public Health System, the Health Care System, and the NonHealth Care Sector
Pages 229-256
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From page 229... ...
They could serve as powerful partners because only together can they achieve the goal of living well across populations and across chronic illnesses. Imagining how public health, health care, and community-based organizations could align to improve outcomes in chronic disease led the committee to develop a conceptual model that frames the interaction among the factors and systems associated with chronic disease and its management.
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also provide care. Governmental public health agencies have been and likely will be important in helping people live well with chronic disabling conditions and other chronic illnesses particularly in their shared role with clinical services to education and support the transition of care.
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, began in 1999 and has focused on community-level approaches to eliminating racial and ethnic disparities in chronic illnesses (CDC, [f] ; Collins et al., 2009)
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. What is known about the effectiveness of many population-focused efforts to improve outcomes for individuals with chronic illness is somewhat limited.
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At the same time that programs and services were increasing, funding for state public health agencies programs remained flat, with median state spending at approximately $29 per capita (Madamala et al., 2011)
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, contains focus areas for health, including policy initiatives, collaborative partnerships, necessary public health resources and infrastructure, needed research, and the data required to track progress. Indicators and Measurement of Population Health Measurement of population health status has traditionally been the role of public health agencies as part of their assessment and assurance functions.
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From page 235... ...
Responses to Emerging Population Health Threats The response of public health to chronic disease has been varied across the nation depending on the infrastructure, workforce, and partners available to the agency and whether they have the resources to pursue interventions at all levels of risk. Although work continues on the development of the evidence base for interventions aimed at risk factors associated with chronic disease, public health efforts to pursue the prevention of disease are complicated by the fact that they must respond at the policy and societal levels, where interventions to modify environments and laws are most effective; at the community level, where public awareness, community campaigns, and school-based and workforce interventions are most effective; and at the individual and family levels, where clinical preventive services are delivered (Halpin et al., 2010)
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Alignment Among Structures and Approaches Aligning public health with potential and current partners, including community-based agencies, health care systems, voluntary health-related organizations, and policy-making bodies, has policy and political dimensions. To be a fully participating partner in the debate around health reform, it will take political and collective action to realize cost-effective strategies for reducing chronic disease; the transition of safety net services to the health care sector; and the strengthening of public health infrastructure to respond to the heightened needs for measurement, surveillance, and population strategies to reduce the impact and development of chronic disease.
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From page 237... ...
is based on the Chronic Care Model and the Expanded Chronic Care Model described earlier in this chapter. The framework brings together efforts around developing individual skills necessary for health, the reorientation of health services to a stronger focus on prevention and health promotion, the development of public policy that promotes health and prevents disease, the creation of environments that support health, and extra strength to community action.
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From page 238... ...
Clearly these features are not supportive of the type of care needed for most chronic diseases. The quality of care of chronic diseases could be improved if health systems were designed on the basis of the characteristics and needs of patients with chronic illnesses (Canadian Ministry of Health and Long-Term Care,
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Ensure Access to Affordable Health Care Fundamental to the implementation of the Chronic Care Model is having a health care system that is designed to provide access to affordable care for all persons with chronic illnesses. According to a 2010 survey by the Commonwealth Fund (Collins et al., 2011)
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This type of payment system is common in the United States and is an incentive to provide more care to more patients with chronic illnesses, since more care provides more income. Few incentives exist to prevent chronic diseases, and there is a potential for overuse of services.
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. Although not typically the focus, P4P could be used in an analogous fashion to reward care coordination, the collective care quality offered by a team of caregivers, or other innovations in chronic care delivery to achieve better outcomes of care.
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. It is too early to determine the impact of the Affordable Care Act on the costs and quality of health care and on overall population health.
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has suggested the formation of health outcome trusts, "a metaphor for local public-private partnerships with market-based incentives to integrate resources across determinants for better health outcomes." Significant challenges must be met before such a population health improvement system could be implemented to improve the care for patients with chronic illnesses. There is no consensus on how to measure population health and its improvement.
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. The consequences of these implications lead to the fact that people living with chronic illnesses now spend a significant amount of their time managing their own care with just a minuscule amount of time being spent at the hospital or in ambulatory care settings.
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Some examples of the Steps Program include improving obesity management and reducing health care costs through worksite wellness programs; promoting healthy behaviors among school employees; and providing transit employees' access to exercise facilities, healthy foods, and health assessments to help them manage their weight (CDC, 2008)
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. There is very scant evidence of worksite programs targeted at people living with chronic illnesses, such as diabetes and arthritis.
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Some initiatives and programs include health and wellness education, including health screenings; senior fitness programs; outreach services, providing an array of services like transportation; meals and nutrition services; employment counseling; social networking opportunities; case management services; legal services; volunteer opportunities; and access to providers to render primary care services. However, the effectiveness of these programs on seniors living with chronic illnesses remains largely untested.
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Although nurse practitioners tend to see younger patients, nurse practitioners saw 39 percent of the patients with one or more chronic illnesses (Hing and Hooker, 2011)
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Movement, an initiative that S promotes walking for a healthier lifestyle • eart 360, an internet tool that H gives people the ability to track their weight, physical activity, cholesterol, blood pressure, and other factors that contribute to heart health • et With the Guidelines, a program G to ensure consistent application of American Heart Association/ American Stroke Association scientific guidelines in the in-patient setting • ou're the Cure, a cardiovascular Y disease and stroke advocacy network Arthritis 1948 To "improve lives • et's Move Together, a program L Foundation through leadership that promotes physical activity in prevention, to prevent and minimize arthritis control and cure of problems arthritis and related • rthritis Today, a magazine focused A diseases" on issues related to arthritis • rthritis Internet Registry, a study A in which people with arthritis fill out questionnaires to advance arthritis science • steoarthritis, rheumatoid arthritis, O and juvenile arthritis research
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From page 250... ...
Although numerous studies have evaluated the impact of worksite wellness programs and lifestyle interventions on health outcomes, the efficacy of these studies is mixed and largely targeted at healthy employees, with only a handful of studies focused on people living with chronic illnesses. The few worksite programs that targeted people living with chronic illnesses were of short duration and small effect sizes.
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From page 251... ...
These organizations can serve as sites for community health workers to deliver evidence-based self-management interventions targeted at people living with chronic illnesses. In the context of the Frieden pyramid of the factors that affect health, ready access to community-based organizations equipped with well-trained staff that can counsel and educate people living with chronic illnesses on recommended lifestyle changes and selfmanagement interventions would certainly yield a far greater public health impact than the individual approaches in health care settings would.
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evaluate existing (e.g., chronic care model, expanded chronic care model) , emerging and/or new models of chronic disease care that promote collaboration among community-based organizations, the health care delivery system, em ployers and businesses, the media, and the academic community to improve living well with chronic illness.
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2008. The Steps Program in Action: Success Stories on Community Initiatives to Prevent Chronic Diseases.
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. Compilation of Patient Protection and Affordable Care Act.
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Structure and functions of state public health agencies in 2007. American Journal of Public Health 101(7)
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2009. A web-based nutrition program reduces health care costs in employees with cardiac risk factors: Before and after cost analysis.
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