Chronic Disease In The 1990s

Rothenberg, R.

doi:10.1146/annurev.publhealth.11.1.267

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…1 Most Americans will have lived with an average of 2.2 chronic conditions for 17 years by the time of their death. 2 The effects of chronic conditions such as cardiovascular disease and diabetes are felt physically, emotionally, and financially and place the patient at greater risk of serious health complications and disability. 3,4 Our society's ability to afford health care depends heavily on our ability to control long-term care costs incurred at the end of life.…”

Section: Introduction T He Va St Majority Of Americans Who Die Eachmentioning

confidence: 99%

Future of End-of-Life Care: The Managed Care Organization Perspective

Brumley

2002

Journal of Palliative Medicine

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INTRODUCTION T HE VA ST MAJORITY OF AMERICANS who die eachyear are elderly patients with a median age of 77 years, typically suffering from slowly progressive, chronic diseases. 1 Most Americans will have lived with an average of 2.2 chronic conditions for 17 years by the time of their death. 2 The effects of chronic conditions such as cardiovascular disease and diabetes are felt physically, emotionally, and financially and place the patient at greater risk of serious health complications and disability. 3,4 Our society's ability to afford health care depends heavily on our ability to control long-term care costs incurred at the end of life. In turn, cost control depends on our ability to manage chronically ill patients effectively. This paper discusses the unique advantages of managed care organizations (MCOs) in developing and financing innovative systems for managing long-term and end-of-life care, presents an innovative model of end-of-life care pioneered by one MCO, and suggests future recommendations. UNMANAGED CARE: A NO-WIN SITUATIONCurrently, patients with a chronic disease experience fragmented care, with multiple specialists often separately managing care at various times and sites, typically with little communication among themselves. Patients and their families manage the transitions among various providers, disease specialists, financial systems, and care settings on their own. 5Of the roughly 2.4 million Americans who die each year, 75% are insured by Medicare at the time of their death. 6 Among these patients, approximately 50% of last-year medical costs are incurred in the last 60 days of life, and 40% in the last 30 days of life. 7 Despite older persons' preference to receive end-of-life care at home, 8 only 20% of deaths occur at home; most other deaths occur in hospitals (57%) and nursing homes (17%). 9Our current system for managing end-of-life care is dysfunctional. If we started anew, what would characterize "good" end-of-life care? Lynn and Schuster 10 and Cassel and Foley 11 have generated separate lists of key principles of care that reflect a reassuring degree of consensus. They strongly imply that a coordinated, interdisciplinary team approach is a prerequisite to achieving good end-of-life care. Such an approach is a hallmark of MCOs, and one reason they are now at the forefront of developing and financing improved models of end-of-life care. MCOS: COORDINATING CARE ACROSS THE CONTINUUMThe fiscal structure of MCOs offers unique opportunities to develop and test innovative methods for managing end-of-life care. As capitated systems, MCOs have the financial and organizational flexibility to integrate all elements of health care-from physicians to financing-into a coherent whole. As Lynn et al. 5 note, "Advantages derived from managed care systems providing quality end-of-life care include coordinated care across delivery sites, interdisciplinary teams, in-

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Section: Introduction T He Va St Majority Of Americans Who Die Eachmentioning

confidence: 99%

Future of End-of-Life Care: The Managed Care Organization Perspective

Brumley

2002

Journal of Palliative Medicine

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“…In 1980, arthritis alone accounted for 142 million physician visits made by patients, and in 1992, arthritis accounted for 3.7 million hospitalizations, 185 million bed days, and 60 million days of lost work at a cost of $64.8 billion (Weinberger, Tierney, & Booher, 1989;Yelin & Callahan, 1995). Despite their prevalence and significant physical, economic, psychological, and social impact (Hoffman et al, 1996;The Robert Wood Johnson Foundation, 1994;Rothenberg & Koplan, 1990), there is at present no known cure for any of these chronic diseases. Moreover, the application of new biological agents, drugs, and surgery, although promising, is insufficient to address the highly complex behavioral, cognitive, physical, emotional, and psychological processes involved in the pathogenesis and progression of chronic long-term illnesses such as diabetes (Jack, 2003) or chronic obstructive pulmonary disease (Bourbeau, 2003).…”

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confidence: 99%

A Review and Synthesis of Research Evidence for Self-Efficacy-Enhancing Interventions for Reducing Chronic Disability: Implications for Health Education Practice (Part I)

Marks

Allegrante

Lorig

2005

Health Promotion Practice

446

212

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Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.

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“…Such chronic diseases are often the consequences of lifestyle choices regarding diet, tobacco, and other factors; in this sense they occur less randomly than infectious diseases. Of infectious diseases only pneumonia and influenza remain among the ten leading causes of death in the U.S. (Rothenberg and Koplan, 1990). The effort of the medical community to cope with chronic disease has led to a greater appreciation for the psychological and social factors that influence incidence and fatality rates.…”

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confidence: 99%

Theology and Epidemiology as Complementary Perspectives on Aging

Mph

2003

Journal of Religious Gerontology

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Chronic Disease In The 1990s

Cited by 3 publications

References 12 publications

Future of End-of-Life Care: The Managed Care Organization Perspective

Future of End-of-Life Care: The Managed Care Organization Perspective

A Review and Synthesis of Research Evidence for Self-Efficacy-Enhancing Interventions for Reducing Chronic Disability: Implications for Health Education Practice (Part I)

Theology and Epidemiology as Complementary Perspectives on Aging

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