Search results

Researchers have spent considerable time studying how racial-ethnic minorities experience poorer health than whites [Townsend, P., & Davidson, N. (Eds). (1990). Inequalities in health: The black report. England: Penguin Press; Platt, L. (2006). Assessing the impact of illness, caring and ethnicity on social activity. STICERD Research Paper No. CASE108 London England), and how low socioeconomic status (SES) can negatively influence health status (Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In: L. F. Berkman & I. Kawachi (Eds), Social epidemiology (pp. 13–55). New York: Oxford University Press]. This research investigates the relationship between class and race and perceived health status among patients with chronic conditions. More specifically, we apply the concept of social capital to assess whether the quantity of health information seeking behaviors (HISB) via social networks mediates the relationship between race and health status, and between SES and health status. Regression, t-test and ANOVA analyses of 305 surveys completed at a chronic illness management clinic in a Northwest research hospital reveal three important findings: first, that social class affects perceived health status more strongly than race; second, that frequency and amount of HISB do not play a significant role in perceived health status, regardless of race or SES; and third, that an interaction effect between frequency and amount of HISB suggests that the way that patients seek health information, and the quality of that information, may be more useful indicators of the role of social capital in HISB than our study can provide.

Only 55% of patients receive recommended care, with little difference found between care recommended for prevention, to address acute episodes, or to treat chronic conditions (McGlynn et al, 2003). The lag time between the discovery of more effective forms of medical treatment and their incorporation into routine patient care averages seventeen (17) years (IOM). Computerized provider order entry (CPOE) has been widely documented as a necessary tool to reduce preventable medication and other related errors but only 7.4% of acute care hospitals in the United States utilize CPOE with appropriate rules and evidence (HIMSS Analytics). The most fundamental building block for CPOE is the evidence based order set, but complexities associated with creating, managing and updating order sets have introduced major obstacles to CPOE implementation efforts. Chronic conditions such as heart disease, diabetes or arthritis affect more than 130 million Americans directly, and account for 7 in 10 deaths. Further, these chronic conditions consume 75% of all healthcare spending, and account for nearly two-thirds of the growth in health spending over the past 20 years -costing the U. S. economy $1 trillion annually (Almanac of Chronic Conditions, 2008 Edition). Estimates suggest the average patient upon hospitalization has 2.75 diagnoses - meaning "appropriate care" must span and synthesize multiple morbidity-specific best practices to effectively administer care to that "average" patient. The traditional approach to treating patients with evidence based protocols requires a physician to perform an ad hoc exercise of "mental merging" - reconciling duplicate candidate orders across multiple order sets to treat a patient with co-morbidities (today's norm). A more clinically effective, productive, and patient safety-centric alternative is to employ a proprietary software merging algorithm. These advanced algorithms remove duplicate orders, resolve conflicts, completes validation of the appropriate medical evidence and organizes the resulting merged order set so the physician can succinctly address the patients' often complicated treatment by focusing on the unique combination of labs, medications, etc. appropriate for the specific presenting conditions. This article describes a patent-pending propriety method of algorithmically merging multiple independent order sets for patients with co-morbid and chronic conditions into a single, maintenance free and evidence-based order set that can be immediately implemented into physician workflow to satisfy "Meaningful Use" guidelines for incremental provider reimbursement based on the American Recovery and Reinvestment Act (ARRA) legislation.

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

Contrary to want-based services, customer participation has got lesser attention in high-credence services like health care. Customer participation for patients with chronic illnesses could be life-threatening and goes beyond the service organization’s physical environment. Realizing the importance of transformative service research in health-care services, this study aims to propose and validate the conceptualization of customer participation for patients with chronic illnesses.

The study uses sequential exploratory research design with mixed method research. The first phase is a qualitative exploration of the nature and meaning of customer participation by synthesizing theory and insights from semi-structured interviews (N = 75) with doctors, patients and paramedical staff. Next, survey data (N = 690) of patients with chronic illnesses is used to validate the proposed conceptualization. Finally, nomological validity was also tested on an additional survey data set (N = 362) using SEM and FsQCA.

The findings reveal that health-care customer participation is a three-dimensional behavioral construct in which a customer can participate by sharing information, involving in decision-making and ensuring compliance. The study also demonstrates that customer participation is a critical driver of satisfaction with life and perceived control on illness.

The research provides policy guidelines for owners and operators of health-care organizations in developing frameworks for collecting participation data, which can be used in strategies for seeking customer participation.

The research conceptualizes and validates “customer participation” as a multidimensional higher-order construct for patients with chronic illnesses, rarely focused in services marketing and management research on health care.

Leveraging information technology (IT) to improve the treatment and support of patients is a widely studied topic in healthcare. For chronic diseases, such as diabetes, the use of information technology is even more important since its effect extends from a clinic environment to patients’ daily life. The purpose of this paper is to investigate the impacts of one widely adopted information technology, the mobile phone, on diabetes treatment, specifically on the complicated process of patients’ health, emotions and compliance.

We leverage a unique longitudinal dataset on diabetes patients’ health status in rural areas of China to study the problem. We also cross-link the dataset with mobile carrier data to further differentiate mobile phone use to phone calls and network use. To address the endogeneity concerns, we apply PSM and a series of instrument variables.

We identify clear evidence that mobile phone use can significantly improve patients’ emotions and compliance, where the effect is generally larger on patients in worse health conditions. While mobile phone calls clearly benefit diabetes patients, we do notice that mobile phone network use has a negative moderating effect with patients’ health condition on improving compliance.

This study not only enriches our theoretical understanding of the role of mobile phones in diabetes management, it also shows the economic benefit of promoting patients’ use of mobile phones, which should be considered by medical care providers and medical policymakers.

This is a report on a recent development of an innovative coordinated care solution named the Care Coordination Centre (CCC), which targets coordinated care arrangements for a populations expected to benefit the most. The purpose of this paper is to identify the patients who might comprise this group, and to assess the best ways to meet their health, community, and social care needs before and after introducing the coordinated care solution across care settings.

This is a summary of the author’s experience in the design and development of a care coordination business model for US providers and UK Clinical Commissioning Groups (CCGs) using coordinated care not only as a cost-cutting tool, but as a mechanism for creating a flexible and responsive patient-centered care. The author makes an assessment of the economic benefits of coordinated care resulting from: the shift to less costly interventions; reduction in readmissions; reduced unplanned admissions; increased time allocation efficiency of healthcare staff; and the overall reduction in per-patient costs.

The health and social care systems in the USA and the UK are facing the biggest challenges in their history. Payers, providers, governments, and communities need to work to build better coordination and integration mechanisms to manage the increasing demand on health and social care in a period of stagnant health and social care budgets. New innovative models of coordinated care have been developed in both countries, at the local economy level, as the health service systems are undergoing crucial transformation from a supply to a demand-based model. In the UK, the Trafford CCG has commissioned a new CCC, responsible for the delivery of high-quality coordinated care. The CCC is designed to function at clinical, service, and community levels across multiple providers to cover, among other tasks, chronic condition patient case management, risk stratification of preventative, elective, and unscheduled care for the whole region.

Insights from the work with Trafford CCG would be of considerable methodological and practical interest to researchers, policy makers, commissioners, healthcare professionals, and innovators.

Health promotion and rehabilitation models of care are valuable for persons with chronic health conditions, but when these individuals are dependent on a life-maintaining technology, such as kidney dialysis, a cure-oriented model may dominate the system within which they receive care. Providers can preserve their monopoly over expert treatment knowledge by defining the key care issues, by limiting patients’ access to expert knowledge, and by discrediting the patient as a responsible actor. Multiple care paradigms can benefit patients with chronic conditions, however, empowering the patient-actor to collaborate with the clinician to maximize functioning and well-being as well as patient survival.

In the context of US kidney disease care in 2020, this chapter highlights challenges of managing COVID-19–related acute pathology, sustaining safe chronic dialysis treatment for individuals with kidney failure during a pandemic, and identifying ways to effectively address intersections of race/ethnicity, SES, and health.

Medical literature and American Society of Nephrology (ASN) online member forum review, and Emory School of Medicine Renal Grand Rounds participant observation: April 2020–March 2021.

Among persons infected with COVID-19, especially persons of African descent, acute kidney injury (AKI) risk was elevated and associated with need for long-term dialysis. Dialysis-dependent chronic kidney disease patients constituted a high-risk group for COVID-19 infection and hospitalization, due to underlying chronic conditions as well as required travel to clinics for multiple weekly dialysis treatments with exposure to possibly infected staff and other patients.

Findings that are discussed are based on a limited time frame. The longer-term impact of COVID-19 for patient outcomes and for the structure of kidney disease care is a fertile area for continued study, especially in relation to broad health equity goals.

Racial justice activism in 2020 highlighted the imperative to address socioeconomic and racially structured inequities in the United States, and health equity goals and strategies that target kidney disease care have been outlined. The acute/chronic continuum of kidney disease care is a fertile area for research that is informed by the COVID-19 experience and population health inequity challenges.

The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs).

A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006.

There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden’s established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices.

There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential.

The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.

This study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses.

This is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs.

Patients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients.

Patients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.