Gap : Quality care coordination is very paramount in managing patients with chronic illnesses. However, this has not been achieved in the current system which is used in many countries around the globe. The current system lacks the quality with regards to their coordination of the patients with chronic illnesses. There is lack of a proper and uniform system which can address the issue of chronic diseases and increase the quality of care to such patients. The current system is fragmented and is uncoordinated and hence is unable to create a system where quality care for the patient with chronic disease can be achieved. To receive “their complex needs, patients with chronic conditions often receive care from multiple clinicians, who may work independently from each other.” In this case, every clinician "may provide one or more of the services that comprise the full spectrum of care the patient needs, such as medical, mental health, rehabilitation, prevention and supportive services." However, this system has a gap which needs to be addressed ("1: Models:: Improving Chronic Illness Care", 2017). It is silo-based and hence lack uniformity which can bring the clinicians together and a enhance communication between them to help in achieving the quality coordination among the patients with this kind of disease. "By functioning in separate "silos," the clinicians (and the clinics and healthcare organizations where they practice) often do not have complete information about the patient's condition or treatment history, a major source of medical errors." This means that there is lack of integration of the medical with non-medical services through proper communication between clinicians, for the patients who suffer from the chronic disease and hence quality has been substantially hampered with this kind of system in place. This is the gap which needs to be dressed.
History: Many years ago, “pioneers such as John Runyon recognized that the effective management of chronic illness requires a new kind of practice designed expressly to help patients meet the challenges of chronic disease.” The basis of this need was to come up with a kind of a coordinated system which would enhance both personal and medical services to help the patients with the chronic illnesses recover fully. For many years, there has been an obstacle for those patients who suffer from the chronic illnesses. The main complaint has been that the services which are being provided by the different number of the clinicians have not been enough to meet the need of the clients. The system which was in place was more of beneficial for those patients who suffer from the infectious disease and others. In many times, it has been pointed out that there is “mismatch between their needs and care delivery systems largely designed for acute illness.” From this, there had been the need to help in coming up with a coordinated system where both medical and non-medical services are integrated to allow for quality services for the patients who suffer from the chronic illnesses.
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Socio-economic background: It is approximated that due to the fragmentation of the system which is in place for the treatment and management of the chronic disease. Studies have revealed that "Patients, who received services from a higher number of providers, a situation is known as fragmentation of care, were more likely to experience gaps in treatment that led to undesirable events such as preventable hospital admissions." “According to the fragmentation hypothesis, care delivery too often involves multiple providers and organizations with no single entity effectively coordinating different aspects of care. Poor coordination across providers may lead to suboptimal care, including important healthcare issues being inadequately addressed, poor patient outcomes, and unnecessary or even harmful services that ultimately both raise costs and degrade quality.” This is a clear indication that because there is a poor system in the care institution in many countries which has not integrated both medical and non-medical services, there is increased cost in treatments and social issues.
Effects and implications: Without addressing this there will have many impacts and implication on the quality of the services given to the population affected by the gap. First, if the gap persists, there will be “Inefficiencies since discrete health care providers will often duplicate laboratory and radiological investigations and other diagnostic services, especially if medical records and other patient care information are not shared.” Moreover, this gap is a hindrance to the patients follow up which is normally very important mostly for the patients who suffer from the chronic illnesses ( Wagner et al., 2017). Alternatively, this system brings about an issue where "Information about a patient's health and treatments is rarely centralized, well-organized or easily retrievable, making it nearly impossible to manage many forms of chronic illness that require frequent monitoring and ongoing patient support". This is an implication that evens the patient’s secrecy or confidentially is highly compromised.
Existing Initiatives
Addressing the gap ;
The fragmented system which has been used in this case has failed flat in achieving quality treatments for the patients diagnosed with the chronic illnesses. Due to this fact, the Chronic Care Model (CCM) has been put place to ensure that there is coordination for the patient suffering from chronic illnesses where there is the integration of both medical and the non-medical services to boost the quality of the treatments in this area. “ The Chronic Care Model (CCM) is an organizational approach to caring for people with chronic disease in a primary care setting. The system is population-based and creates effective, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team.” CCM is different from the existing system since it identifies essentials "elements of a health care system that encourage high-quality chronic disease care: the community; the health system; self-management support; delivery system design; decision support, and clinical information systems." this ensures quality among the patients.
Goal: The goal of coming up with the CCM was to encourage the integration of both medical and non-medical services in the hospital to improve quality of care delivery to the patient who is diagnosed with the chronicle illnesses. In this case, it was to develop the health system which promotes quality and safety. It also enhances community resources to meet patients need; it increases the self-management support for the patients and also “ Assure effective, efficient care and self-management support.” Furthermore, this system aims at enhancing information sharing among patient and doctors and the clinician themselves.
Developments: The CCM aimed at improving the existing system to help in achieving quality care for the patients with the chronic condition. For this reasons, some aspect of the old system was to be adjusted or changes substantially. The first developments were the health system which was improved to enhance safety and quality care among these patients. The next was the patient's self-support which was included in the follow-up –program, community involvements in improving recovery, and also the clinical information system in the old system was also upgraded and developed to have a system where the patients and clinicians can be timely reminded of drugs and follow-up programs.
Resources & need for improvements: the first resources needed are the human resource. There is the need of more medical personnel that will enhance quality through enhancing follow-up for the patients. Currently, the shortage of the workers has paralyzed the entire system and has made it had a quality care in this hospital for the patients suffering from chronic illnesses to be achieved. Financial resources are required for support all of the systems in the most of the facilities in the world. The existing system has failed since there is a shortage of the staffs to help in enhancing follow-up program to help this patient achieve maximum recovery. Alternatively, the research has shown that as many patients are not involved, there are high chances that the system in places does not address the real need of the patients. All these require improvements and have been achieved through the CCM.
Regulation
The most current regulation on this issue is the Medicare reforms which are aimed at improving coordination for the patients diagnosed with the chronic illnesses. The primary aim of this change and legislation is to ensure that there are enough medical professionals to take care of the chronically ill patients. The improvement also aims at improving the technology in this sectors to enhance research on the patient coordination and how information can be more secure to ensure that patient confidentiality is enhanced. This legislation is critical also because with it comes flexibility due to more resources which will be availed by the Medicare and Medicaid to help in follow-up for the patients ( Kavita Patel, 2017). The legislation also includes “increased financial support for coordinating care for the sickest patients, greater use of technologies and financial support for appropriate home health care, greater flexibility for supplementary benefits in Medicare Advantage, and ways to support continuing innovation in Medicare.” this regulation is being addressed at the federal level in conjunction with the states and the Congress.
Conclusion
CCM is the best system which can have the issue of quality and coordination for the patients who suffers chronic illnesses addressed. The system integrates both medical and non-medical services to bring about coordination in dealing with chronic diseases to enhance quality in its treatments and management.
References
Patel, K. (2017). Medicare reforms that will improve care coordination for chronically ill patients . Brookings . Retrieved 25 October 2017, from https://www.brookings.edu/blog/health360/2016/06/27/medicare-reforms-that-will-improve-care-coordination-for-chronically-ill-patients/
Wagner, E., Austin, B., Davis, C., Hindmarsh, M., Schaefer, J., & Bonomi, A. (2017). Improving Chronic Illness Care: Translating Evidence Into Action . Retrieved 25 October 2017, from
Models: Improving Chronic Illness Care . (2017). Improvingchroniccare.org . Retrieved 25 October 2017, from http://www.improvingchroniccare.org/index.php?p=1:_Models&s=363
