Quality Care Coordination for Chronic Illness Patients
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Quality Care Coordination for Chronic Illness Patients
Gap
There is a gap in quality related to care coordination for people with chronic illnesses. Since patients with chronic diseases are so many, it becomes more likely for them to suffer from poor quality services form the health workers. The high costs associated with taking care of the patients also largely contributes to the situation of poorly coordinated care services for those patients. Another factor that contributes to the existence of the gap is the factor of lack of adequate knowledge by the care providers on chronic illnesses, which include diabetes, which also makes it hard for them to cope with the increasing cases of the conditions. As a result of the lack of knowledge effects such as adverse drug prescriptions, duplicate tests or tests and procedures that are unnecessary, high health care costs, and contradictory information from different health care provider is witnessed in the health care system.
History
To overcome the gaps that exist in the quality of care coordination for the patients with chronic diseases, both patients and health care providers are struggling to come up with ways of reducing these gaps, which include gaps in knowledge, assurance on how to manage chronic diseases, and also in education. The gaps exist due to various reasons; for instance, the fact that most people suffering from illnesses don’t know how to manage their conditions. This is seen as a report by West states that 39% of patients lack adequate knowledge on how to efficiently engage in activities that promote their chronic care (Socías et al., .2016). The same report shows that an average of 60% of the patients with chronic illness disclosed that they are not taking any measures to manage their chronic diseases. The issue of the gap in quality related to care coordination for individuals with chronic conditions is an old issue that has been there for a long time, and there have also been measures that were put in place to reduce the gap. Partnerships for Solution in 2014, wrote a report that stated that almost 48% of the US population had chronic conditions, and the total costs associated with the care of the patients were 83% of the total healthcare costs, which made it difficult for all the patients to be well taken care of in hospitals. Health care systems, policymakers, and research communities for many years have, therefore, tried to come up with ways to ensure that the gap is reduced and the issues are solved.
Social-Economic Background
One of the factors that prevent patients with chronic diseases from accessing health care includes the socioeconomic factor. Family, class, ethnic and race, self-health perception, educational attainment, and health insurance are the main determinants of the patients who access appropriate health care services. For instance, patients who have health insurance are inclined to have better access to the services compared to those who do not have. Also, patients who are highly educated also tend to seek more medical care as compared to those with low levels of education since they are aware of the importance of seeking medical attention. Chronic patients from families with high income and class also get better health care services. People who are very concerned with their health, therefore, pay more attention to the services provided on the quality, especially.
Affect
The leading cause of health care inequality is the high costs associated with the provision of the services. There are also other reasons for health disparities, for example, racial and ethnic differences that determine the race that gets better access to health care as compared to others. The social policies that are in a country may also cause social inequality. As a result, the incongruity causes an escalation in health care costs and therefore impacts the quality of services that are provided.
Impact
An increase in health costs is one of the impacts of health disparities. The health disparities also lead to the compromise of behavioral justice as it raises questions on the fairness and equality of a system. It also has moral and equality implications in that the health disparities are seen as morally wrong, especially if it discriminates, for example, on race. It is thus essential to consider the impact of health disparities on moral and behavioral justice and also on costs.
The existing Initiative
The establishment of professional specialist associations is one of the measures put in place to address the gap. The associations were formed to seek further to the profession that deals with care coordination for patients with chronic illnesses. Consultant care was available to only a small percentage of patients with chronic diseases in the past, and therefore there was a need to come up with the association of specialists dealing with the care coordination of chronic illness patients. Patients are referred by most general practitioners to specialists who can provide special good quality care to the patients. This scenario is a result of the fact that the general practitioners deal with a lot of people and illnesses, and thus they lack the know-how of caring for patients with carnival illnesses. Specialists, on the other hand, have majored in the areas and are experts, and therefore the patients can benefit more from them more as compared to the general practitioners who have many patients to take care of. Thus, the specialists work closely with the general practitioners and consultants to promote the management and caring of these patients with complex illnesses such as diabetes.
Goals of the existing Initiative
The goal for the establishment of the professional specialist associations was to help the patient get special care from experts since care coordination for patients with chronic illnesses requires special attention. One factor that makes it difficult for the patients to be well taken care of is the complexity of the chronic diseases, which creates the need for specialists since most people do not know how to go about it. A patient-centered health care system is required to ease the care coordination of patients with chronic illnesses among the many health professionals. The association also aims to define health care team obligations and delivering evidence-based care that patients can understand and appreciate. Another goal of professional specialist associations to create community linkages through developing partnerships with other organizations of the community, which will intern support the interventions aimed at improving care coordination for patients with chronic illnesses. The model, therefore, aims to redesign and improve the quality of constant care delivery by enabling specialists to handle the patients.
Circumstances around the Development of the existing Initiative
The American College of Physicians is an example of a specialist association that was established in the early 1900s. Groups in professional specialist associations comprise the American Geriatric Society and the Society for Primary Care and all support for the care coordination of patients with chronic illnesses (Sheaff et al., 2017). The societies have also advocated for financial incentive programs that enable the performance of care coordination errands. The Weida of the American Academy of Family Physicians, Thomas J., for instance, is an individual who advocated for the financial incentive program as he asked for the reimbursement of fees paid by patients with chronic conditions stating that they need not be charged. Thomas also argued that care management involves developing a close relationship with the patient and developing a care plan, and therefore patients should not be charged. Some of these associations are also in the cue for finding the causes and better cures for the diseases. Groups like Disease Management Association of America, for instance, is undertaking research efforts that involve regulation of outcomes assessment metrics and providing satisfaction measurement tools to evaluate the quality of care given to the patients. The association has also played a role in educating the public about chronic illnesses; for example, they have developed a dictionary that contains all terms of disease management. Through this beneficial process, they have established a practical guide to disease management program evaluation.
Resources Required to Fund the existing Initiative
The professional specialist association requires some resources to be able to run their operations efficiently, and these resources include financial resources. Some of the groups that perform research on chronic illnesses and care coordination of the patients suffering from the diseases do not have adequate funds to carry their research effectively. The funds are necessary to help in reaching out to many people to create awareness, and through this, many people will be aware of how even to prove self-care treatment without the help of the specialists. Another resource that the Initiative requires is more human resources. More specialists are needed since the number of patients suffering from chronic illnesses is on the rise. In efforts to counter this rise, more people should specialize in learning how to take care of the patients to ensure that the quality gap is reduced and, in the long run, eliminated. Government support is also required to fund the initiative, for instance, in giving funds to the associations. The government can, therefore, provide tools and facilities to the association for them to provide quality care coordination.
Improvement of the Initiative
Some of the reasons why the professional specialist association initiative is not meeting its intended purpose are because of the limited resources, and many people suffer from chronic illnesses, and therefore it makes it hard for the associations to cater to the patients. Since the specialists are also limited in number, it prevents the appropriate care of the patients since one specialist has to care for many patients all at once. For quality coordination of health care, the providers of health care thus need to establish close interactions, which becomes hard if a healthcare provider is overwhelmed.
Current regulation
The current regulation of the professional specialist associations includes the guidelines set for licensure, accreditation, and certification of the bodies. The strict measures have been put in place to ensure that the institutions provide a high quality of health services. As there are growing interests in the health sector, many professional bodies may be the establishment, and their primary purposes may not be to reduce the gap or advance the quality of health care with chronic illness patients. For this reason, the need to enact strict regulation arises to prevent those specialist associations who are, for instance, after profit from entering the market. Some of the rules, for example, in-licensing include the inspection of educational health programs, the examination of an individual’s credentials, and also the administration of examinations to test the professional qualifications of the specialists. If the professional bodies were allowed to operate without any regulations, then that would even cause the health care delivery gap for patients with chronic illnesses to increase instead of reducing it since the patients would be offered low-quality services. Therefore, the current regulation on matters of licensing, accreditation, and certification help to filter out the professional specialty associations that do not aim to reduce the health care delivery gap of chronic patients.
The regulatory level
The current regulations are being addressed at the federal level. This is because the laws and regulations passed were passed in the congress and therefore apply to all the professional specialist associations in the whole country. Other levels that the rules are being addressed are also at the state level, where the registration of the professional bodies takes place. Departments such as the Department of Health and Human Services are in charge of also ensuring that the professional specialists association deliver the right quality of health care to patients with chronic illnesses such as diabetes. The primary levels that the professional specialist association is regulated are, therefore, the federal and state level.
Conclusion
Formation of professional specialist associations has, in a major way, aided in the provision of care for patients with chronic diseases. The goal for the formation of the associations was to help patients get devotion from experts. Through it, the patients deal with specialists and not general caregivers, and therefore, they can receive quality care. The regulations that have been put in place have helped control the establishment of fake professional specialist bodies that are not interested in providing high-quality care for patients with chronic illnesses but instead have their motives, for instance, to make profits. This has been done by putting in place strict measures in the licensing, accreditation, and certification of the professional bodies. The Initiative aligns with other initiatives as the Initiative like theirs aims to improve the quality of health care coordination by giving special attention to patients with chronic illnesses. There are, therefore, nonconflicting interests between the Initiative of the establishment of the professional specialist association and other initiatives aimed to reduce the gap in quality related to coordination for individuals with chronic illnesses.
References
Sheaff, R., Halliday, J., Byng, R., Øvretveit, J., Exworthy, M., Peckham, S., & Asthana, S. (2017). Bridging the discursive gap between lay and medical discourse in care coordination. Sociology of health & illness, 39(7), 1019-1034.
Socías, M. E., Volkow, N., & Wood, E. (2016). Adopting the ‘cascade of care’ framework: an opportunity to close the implementation gap in addiction care?. Addiction (Abingdon, England), 111(12), 2079.