...Disease Management: Empowering Patients and Improving the Effectiveness of Patient Care Disease Management: Empowering Patients and Improving the Effectiveness of Patient Care Managed care organizations are continually searching for new ways to cut costs and people trying to manage an illness or disease are looking for ways to ease their symptoms, maintain their lifestyle, and stay out of the hospital. People with diseases are in the unique position for managed care organizations to focus cost saving programs on. Diseases can be incredibly expensive to treat and while people suffering from diseases are not a majority of patients, they are certainly the most costly (Lorig & Holman, 2003). Disease management programs can also motivate patients to change their lives by better managing their disease and get those diseases under control by giving patients the skills and expertise necessary. Disease management programs seek to change the approach to patient care with regards to difficult conditions by incorporating evidence based medicine techniques and outcomes that can contribute to the wellness of patients by using combinations of education, provider practice guidelines, consultations, appropriate drug utilization, supplementary drugs and services. Focus on these areas can keep patients illnesses from reaching emergent care levels as well as reducing the outlay associated with high–cost diseases. Disease Management History Chronic conditions make up more than 40...
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...Self-Management Education: History, Definition, Outcomes, and Mechanisms Kate R. Lorig, Dr.P.H. and Halsted R. Holman, M.D. Stanford University School of Medicine ABSTRACT THE MEANING OF SELF-MANAGEMENT Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks—medical management, role management, and emotional management—and six self-management skills—problem solving, decision making, resource utilization, the formation of a patient–provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems. Whether one is engaging in a health promoting activity such as exercise or is living with a chronic disease such as asthma, he or she is responsible for day-to-day management. Gregory Bateson (3) once said, “one cannot not communicate.” The same is true for health behavior and disease management. One cannot not manage. If one decides not to engage in a healthful behavior or not to be active in managing a disease, this decision reflects a management style. Unless...
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...Diabetes Disease Management Organizational Change Plan Diabetes Disease Management Organizational Change Plan Diabetes is a chronic disease in the United States and is reaching epidemic proportions. Private health care organizations have incorporated disease management programs to assist insured members in managing diabetes care and treatment. In an effort to contain cost, disease management programs employ nurses, dieticians, and physicians to provide diabetic education, resources, and incentive programs as a collaborative effort to assist members with this chronic disease (Edwards, 1999). The United States Department of Health and Human Services estimates that 25.8 million individuals of all ages have been diagnosed with diabetes. This chronic disease is the seventh leading cause of death. Medical treatment for a diabetic is twice as high as it is for a non-diabetic patient. The United States Department of Health and Human Services estimated that in 2007 medical treatment for diabetics cost $174 billion dollars (Centers for Disease Control and Prevention [CDC], 2011). This paper will provide documentation of a declining disease management program and the development of a change within the organizational program. The goal of the change will provide patient, physician, nurse collaboration, diabetic education, and, assistance with self-management to close gaps in care (Amundson, O'Connor, Solberg, Asche, Woods, Parker, & Crain, 2009). Mercy Care Management is a...
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...Approaches to Disease Management in Managed Care DeVry University `12/11/15 Table of Contents 1. Introduction…………………………………………………………….. Page 3 2. Background…………………………………………………………….. Page 4 3. The Challenges and Problems Associated with Disease Management…….. Page 6 4. Review of the Research and Literature…………………………………… Page 8 5. Challenges/Problems Analysis with Disease Management……………….... Page 9 6. Recommend Solutions of Improvements in Disease Management…………..Page 10 7. Implementation of Solutions in Disease Management in Managed Care Industry..Page 11 8. Justification………………………………………………………………… Page 12 9. Summary and Conclusion…………………………………………………...Page 14 10. Works Cited-References………………………………………………….. Page 16 Introduction It is very well known how most physicians or healthcare facilities and organizations handle diseases in our society in my opinion. Managed care for diseases are mostly not focused on, it is for large populations. But typically physicians do try to focus on individuals however once you throw MCO in the mix it becomes similar to a farmer caring for cattle which I hate to say. And I am very much passionate about this subject because of my experience in the very arena. Before I had a stable job with wonderful health insurance, I relied on government paid insurance for a minute and during that time I was diagnosed with Lupus which is a autoimmune disease with no cure. However, while battling this disease I realized...
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...Personal Impact Paper: Lyme Disease Eric Bickhart University of Phoenix student NUR/427 August 4, 2014 Amy Highland Personal Impact Paper: Lyme Disease “Since its identification nearly 30 years ago, Lyme disease has continued to spread, and there have been increasing numbers of cases in the northeastern and north central US. The Lyme disease agent, Borrelia burgdorferi, causes infection by migration through tissues, adhesion to host cells and evasion of immune clearance” (Steere, 2004). This disease is transmitted to humans from the bite of the Blacklegged (deer) tick. It usually produces a bulls-eye rash, but not in all cases. According to National Library of Medicine (2013), "Stage 3 or late disseminated Lyme disease can cause long-term joint inflammation (Lyme arthritis and heart problems. Brain and nervous system problems are also possible" (Outlook (Prognosis)). Lyme disease has afflicted a high school basketball coach and gym teacher of a small school in Liberty, Pa at age 36. He is the father of two children and a member of a local sportsman's club. He has been dealing with the ongoing symptoms related to chronic Lyme disease for about seven years. It has been a life altering disease for a previously active young man. He reports symptoms as severe pain and swelling in all of his joints that inhibit full rotation similar to rheumatoid arthritis. Also, he has persistent severe back pain which keeps him on the sidelines during most of his career and...
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...the system and to the healthcare consumer. In practice Managed Care Organizations take a variety of shapes and thus there is no one fit all model that works ideally for each type of healthcare organization. In terms of the disease management of chronic long-term conditions, MCOs can offer services at cheaper cost than the fee-for-service model. A key function of a manage care system with a disease management inclusion is the integration between all of the providers providing care. This paper will primarily act to define disease management and give a brief overview of its clinical framework....
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...Companies in Disease Management Abstract This paper will analyze the increase in healthcare costs that has attributed to a trend in health insurance plans’ and employer groups focus on disease management through emphasis on wellness programs (Ex; health club credits), and disease management with the hopes of preventing and decreasing the number of insured’s with chronic illnesses. Disease management is defined as a systematic approach to coordinated health care that seeks to identify individuals and populations who are at risk of developing certain chronic medical conditions. In the past couple of years, health insurance companies such as Blue Cross Blue Shield, Aetna and United HealthCare have implemented various extensive disease management programs with a goal of prevention rather than cure. The Role of Health Insurance Companies in Disease Management The main goal of chronic disease management is to help patients self-identify any irregularity before the condition progresses to a life threatening. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition. These conditions include but not limited to; arthritis, asthma, cancer, cardiovascular (heart) disease, and diabetes, though these are only a few of many chronic illnesses that negatively impact the lives of Americans (Centers for Disease control, 2013). According to a survey conducted by Hewitt Associates (2001), 76 percent of employers availed disease management programs...
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...Multimorbidity is a clinical condition which is defined as a state where three or more chronic illness conditions prevail in a patient either centrally or dependant upon one or more central condition (Fortin et al., 2007). This clinical condition is characterised by overlapping pathophysiology, synergetic disease intensity and intersection of individual illnesses management (Boyd et al., 2010). Few examples of the composing illnesses include coronary heart diseases, dyspepsia, migraines, sleep disturbances, bowel imbalance and Sarcopenia ( Fortin et al., 2007) Prevalence of multi morbidity varies across different parts of the world depending upon variance of population sample, age group of the society, advancement of health care monitoring systems and ethnic conditions. In developing countries like most of the Asian countries, rates of life expectancy are reported to increase due to advances is environmental and working conditions of the population. With the increase in life expectancy rates, the prevalence of coexistence of these diseases also steeply increases and is directly proportional (Akker et al., 1998). Further more, the prevalence of this clinical condition is more in developing countries when compared to that of developed countries due to increased percentage of vulnerable groups like young children, diseased and unattended patients and poor economical conditions (Valderas et al., 2009). The government of UK launched a initiative in collaboration with the NHS...
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...Chronic obstructive pulmonary disease (COPD) is an umbrella term for people with chronic bronchitis, emphysema, or both. With COPD the airflow to the lungs is restricted (obstructed). COPD is usually caused by smoking. Symptoms include cough and breathlessness. The most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucus-thinning (mucolytic) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms Chronic obstructive pulmonary disease (COPD) is a general term which includes the conditions chronic bronchitis and emphysema. COPD is the preferred term. • Chronic means persistent. • Bronchitis is inflammation of the bronchi (the airways of the lungs). • Emphysema is damage to the smaller airways and air sacs (alveoli) of the lungs. • Pulmonary means 'affecting the lungs'. Chronic bronchitis or emphysema can cause obstruction (narrowing) of the airways. Chronic bronchitis and emphysema commonly occur together. The term COPD is used to describe airflow obstruction due to chronic bronchitis. Furthermore COPD is an ongoing and a terminal disease that can have effect on patient daily living (Blackler et al. 2007). In this project, the topic chosen is Developing Self management plans to help people with COPD to control their condition. The key intervention innovating on is the development of COPD care checklist. This is due to how...
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...Nurse’s role in Facilitating the Patient to Cope and Promote Self-Management. Having Established Renal Failure (ERF) can be a life changing experience. Starting dialysis is a major life change for people with ERF. All of a sudden they are faced with the need to make a drastic change to accommodate their new dialysis schedules into their live Additionally patients will have to learn to carefully assess their diet and fluid intake as well as follow medication regimens that tend to be challenging. Even though peritoneal dialysis offer more flexibility and independence, but remain challenging. Patients tend to experience emotional upheaval due to treatment-related fatigue, the change in their life due to dialysis, and potential concerns about body image. Particularly challenging is the suddenness with which many are forced to absorb all these challenges. Patients express feelings of fear and anxiety about how much they have to learn and make many decisions all at once. Dialysis affects patients’ schedules, relationships, family roles, productivity, finances, sexual function, and physical appearance....
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...Health Care Systems for Chronic Disease Management based on Human Factors and Ergonomics (HFE) Principles Introduction The time patients spend in clinical institutions has become significantly shorter. There was a shift from hospitalization to home health care for chronic diseases management in the U.S. einmid-1980s due to the employment growth (Carayon, 2011, p.743). According to the 2010 U.S. Bureau of Labor Statistics, the employment growth in hospitals is expected to be 10% while employment in smaller home health services is expected to grow at a rate of 46% (cited inCarayon, 2011, p.743). At the same time, chronic diseases, which can only be controlled but not cured at current level of medical research, are making greatly negative impacts on the society. About half of the adults in the U.S. suffer from at least one chronic illness such asdiabetes, asthma and a range of disabling neurological conditions (Haddad &Chetty, 2012, p. 285), and about 70% of the deaths in the U.S. can be account of chronic diseases (CDC, 2012).Because of the shortage medical staff at hospitals and clinics, and the long term care requirement of chronic disease patients, home health care is regardedas the best option to manage patients’ health. A home healthcare system typically consists of patients, medical contact centers and medical staff. Medical Contact Centers (MCCs) perform as the communication link between medical staff and patients with chronic diseases where patients upload their...
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...Teaching plan for a new-onset juvenile diabetic Introduction Diabetes causes chronic health conditions and comorbidities, and if left untreated it has negative health consequences for individuals and also nation’s economy. According to a 2014 report from Centers for Disease Control and Prevention (CDC) conducted in 2012 that diabetes affects more than 29.1 million Americans and of them 8.1 million are undiagnosed (CDC,2014). The estimated cost of Diabetes in the United States in 2012 was 245 billion dollar that includes medical cost, disability, and premature death (CDC, 2014). According to Healthy People 2020, diabetes is the seventh leading cause of mortality, lowers life expectancy by up to 15 years, increase the risk of heart disease, kidney failures, blindness, and so forth (U.S Department of Health and Human Services, 2014). Type I diabetes is one of the most common endocrine diseases of childhood which is why it is also called juvenile onset diabetes. It is an autoimmune disease where the beta cells of the pancreas are destroyed resulting in the inability of insulin production. People with type I diabetes need to take insulin daily to regulate their blood sugars (Lamb, 2015). Background and Importance of Research Diabetes is a severe and chronic disease that causes chronic disabilities. The inability of the pancreas to produce insulin results in abnormally high blood sugar levels. Over years, high blood sugar levels can damage...
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...Access to health care is limited in the rural setting so it becomes imperative to educate the patient regarding their illness, treatments, management, medications and when to seek medical assistance. Providing this information to the patient and educating them, the patient is better able to self-manage their condition. Kouame (2010), identified the key challenges facing the rural population as: low population density, limited to no services, disproportionate numbers of elderly, low-income, and minorities, social isolation and a high incidents of chronic illnesses. Health promotion is defined as the process of enabling people to increase control over and improved their health. Improving health literacy is key in empowering the rural community...
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...Abstract In recent years, diabetes has become one of the top 10 causes of death among women. Research has revealed that women 65 years and older account for 40% of the population and numbers are expected to increase exponentially. Vigorous medication management and coordination of care is instrumental in treating diabetes effectively. The patchwork of health insurance that exist today, particularly Medicare Part D, is culpable in allowing unequivocal disparities among race, gender, and socioeconomic status. This paper will examine quality of care among Medicare beneficiaries, particularly women, and implications for revision in social policy. Maintaining an active and healthy lifestyle is a necessity for achieving longevity. A nutritional, well balanced diet coupled with regular exercise is a simple, yet effective way to sustain healthy living. Neglecting to address diet and exercise, as part of a weekly regimen, is a precursor to the onset of an acute, lifelong illness. Diabetes is one of the largest and fastest growing causes of chronic disease mortality, morbidity, and disability in the United States (Robbins & Webb, 2006). Currently, there is no vaccine to prevent diabetes and no cure for the disease once acquired. According to the American Diabetes Association, more than twenty-three million Americans have diabetes. Patients age 65 years or older account for approximately forty percent of all cases, the largest percentage of any age group (Fisher,...
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...Diabetes Mellitus is a common chronic disease of the endocrine system, specifically the pancreas, which beta cell destruction leads to insulin deficiency. Type 1 Diabetes Mellitus is an autoimmune disorder triggered by a viral infection in which beta cells are destroyed leading to absolute insulin deficiency and usually diagnosed in childhood. Type 2 Diabetes Mellitus is a progressive disorder in which the pancreas makes less insulin overtime; most cells reduce the ability to respond to insulin, poor control of liver glucose output, decreased beta cell function, and eventually beta cell failure. The specific cause of type 2 diabetes is unknown; however, it usually occurs in adulthood, heredity, obesity and sedentary lifestyle may play a major role in its development. For both types of diabetes the main feature is chronic high blood glucose levels (Ignatavicius & Workman, 2006) This disease process requires lifelong behavioral and lifestyle changes and complications from this disease can cause many devastating health problems. This paper will include an overview of the incidence of diabetes in the United States, typical presenting signs and symptoms, the potential chronic affects of diabetes on the body, teaching with measurable outcomes and the psycho-social challenges a patient may face. Incidence of Diabetes in the United States According to studies performed by the National Institute of Health (NIH), 13% of adults 20 and older in the United States have diabetes. ...
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