The Chronic Care Model as a vehicle for the development of disease management in Europe - PowerPoint PPT Presentation

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The Chronic Care Model as a vehicle for the development of disease management in Europe

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Title: PBL: Theory and Practice Author: O&O Last modified by: cspreeuwenberg Created Date: 12/4/2003 11:04:51 AM Document presentation format: Diavoorstelling – PowerPoint PPT presentation

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Title: The Chronic Care Model as a vehicle for the development of disease management in Europe


1
The Chronic Care Model as a vehicle for the
development of disease management in Europe
  • Professor Cor Spreeuwenberg MD PhD
  • Department Social Medicine
  • Faculty of Health, Medicine Life Sciences
  • Maastricht University
  • INIC-Conference Gothenburg, 6th March 2008

2
Content
  • Chronic Diseases
  • Some care approaches
  • The Chronic Care Model
  • US and Europe
  • Conclusions

3
Chronic diseases world wide
4
Chronic Diseases
  • disaster or blessing?

5
Aims of chronic care
  • prevention or delay of manifestation(s), where
    possible
  • improved functioning of patients
  • - reducing symptoms and complications
  • - prolonging lifespan
  • - improving quality of life
  • - living independently
  • - according own needs, demands and preferences
  • effective, efficient and safe health care delivery

6
Challenges of chronic care
  • access
  • prevention lifestyle
  • integrated care
  • effective and efficient care (delivery)
  • co-morbidity and multi-morbidity
  • tailoring to the needs of patients
  • support of self-management
  • organization on different levels
  • care management support
  • manpower

7
Do we treat all aspects effectively?Results of
systematic approach of people with diabetes (N
15.269) at T0, T12, T24
8
Lessons
  • Supporting practitioners to improve their medical
    skills seems to be more effective than paying
    attention to behavioural interventions
  • However
  • There are al lot of indications that most
    practitioners are not skilled in applying
    behavioural interventions
  • Behavioural interventions require different
    approaches, time-sets and ways of patient
    involvement

9
Approaches to improve chronic care
  • quality integrated care
  • efficiency disease management
  • outcomes Chronic Care Model
  • Question do these approaches exclude each other?

10
Integrated care- definition WHO (Gröne,
Garcia-Barbero), 2001- presented on
IJIC-conference in Strassbourg, 2002
  • Integrated care is the bringing together of
  • - inputs, delivery, management and
    organization of services
  • - related to diagnosis, treatment, care,
    rehabilitation and health promotion.
  • Integration is a means to improve services in
    relation to access, user satisfaction and
    efficiency

11
Integrated care(Kodner/Spreeuwenberg, 2002)
  • pragmatic definition a step in the process of
    health systems and health care delivery becoming
    more complete and comprehensive
  • contains a coherent set of methods and models on
    funding, administrative, organizational, service
    delivery and clinical levels
  • designed to create connectivity, alignment and
    collaboration within and between the cure/ care
    sectors
  • aims to enhance quality of life, consumer
    satisfaction and system efficiency for patients
    with complex, long-term problems cutting across
    multiple services, providers and settings

12
Disease Management- definition according to DMAA
(2004)
  • a system (of)
  • coordinated
  • health care
  • interventions and communications (for)
  • populations with conditions (in which)
  • patient self-care efforts (are)
  • significant

13
Disease managementbackground
  • originally an American concept
  • one disease or health problem
  • feedback mechanism based on management
    information
  • focus on efficiency more than on quality
  • population orientation
  • programmatic, systematic approach
  • usually organized by a third party

14
2007 DMAA changed its name to Care Continuum
Alliance
  • care continuum includes strategies such as
  • - health and wellness promotion
  • - disease management and
  • - care coordination
  • Care Continuum Alliance promotes the role of
    population health improvement in
  • - raising the quality of care
  • - improving health outcomes and
  • - reducing preventable health care costs
  • for people with - or at risk for developing
  • chronic conditions

15
The Chronic Care Model
16
Chronic Care Model Aim
  • To improve functional and clinical outcomes
  • by relating processes on different levels
  • - patient
  • - practice team
  • - organization responsible for the practice team
  • - health care system
  • - society

17
Chronic Care Model central issue
  • Creating a productive set of interactions
  • between patient and practice team

18
Informed, activated patient
  • Application of principles of citizenship
  • patient as owner of the disease
  • understands principles of treatment
  • able to make informed choices
  • able to cope with relevant technology
  • knows signs/symptoms of complications
  • knows who to call for support
  • active in preparing the next consultation
  • This is an intention, but keep in mind that not
    all
  • patient are capable to act on this way!

19
Self-management
20
Support of Self-management -
information and education of patients -
21
Prepared and pro-active practice team
  • Competence in clinical care, attitude,
  • organization and communication
  • up-to-date knowledge and skills
  • multi-disciplinary team
  • accessible and transparent
  • ready to support and to inform
  • front- and back office
  • co-operation issues
  • delegation of tasks, if justifiable
  • application modern technology

22
A Network Information and Collaboration System
Personal Health Management
Patient
23
Chronic Care Model related components or
conditions
  • Community-level
  • . resources and policies
  • Health care delivery system-level
  • . health care organization
  • . delivery system design
  • Practitioners/team-level
  • . clinical information systems
  • . decision support
  • . self-management support

24
Evidence based strategies with high success
factors
  • Support of self-management
  • - preventive messages (web etc.)
  • - self care education
  • Practice-level
  • - disease registries to identify and track
    people
  • - risk stratification models
  • - services in community settings
  • Substitution from physicians to nurses

25
Europe its health systems and chronic care
approaches
  • EU or related position
  • health care national issue
  • nationalized and mixed
  • public/private systems
  • various ways of organization
  • various approaches to market mechanisms
  • various ways of chronic care management
  • cf Ellen Nolte

26
Europe disease management and Chronic Care
Model general picture
  • much support for CCM
  • disease management initiatives independent from
    nature health care system
  • disease management approaches compatible with
    CCM-model
  • discussions within governments about their role
    in implementing disease management
  • success also dependent of role of professionals

27
Converging of American and European chronic care
approaches
  • stratification based on complexity and patient
    features
  • continuum of care
  • connectivity of personal, practice and system
    levels
  • prevention - and lifestyle influencing
  • support of self-management
  • availability and interconnectiveness of
    information
  • quality control and improvement mechanisms
  • improved functioning of the health care team
  • information technology

28
Example StratificationUS-Ka
iser NL-Matador
Permanente
  • 2
  • Highly complex patients
    Highly complex patients
  • - Intensive case management
    - medical specialists
  • High risk patients
    Moderate complex pts.
  • - Disease Management
    - specialized nurses
  • Vast majority of pts
    Non-complicated pts.
  • - Supported self-care
    - practice nurses/GPs

1
____________
________________________
3
29
From challenges to changes
  • Implications
  • - organisational
  • - status and tasks of professionals
  • - educational
  • - financial
  • Implications of change are significant, but
  • the implications of not changing are even
    more significant

30
Chronic Care Model (its principles) as a vehicle
for disease management approach
  • DM-approach
  • - provoked by new health legislation (2006)
  • intended for all chronic diseases with important
    prevalence, starting with diabetes
  • new entities, often regional embedded, which
    function as organizer and contractor
  • most entities formed by GPs
  • insurers supposed to set the rules
  • entities subcontract concrete caregivers
  • data gathering bij a national institute (RIVM)
  • starting problems (ICT)
  • at this moment weak attention for CCM-aspects

31
Opportunities to integrate disease management
approach with CCM
  • development of care standards
  • (how to use guidelines in daily practice)
  • subjects
  • . diabetes, COPD, cardiovascular risk
    management
  • . to be developed heart failure, depression
    etc.
  • . newly written care standards take CCM as
    starting
  • point
  • Conclusion
  • CCM can function as a vehicle to introduce
  • a adapted way of disease management

32
Main messages
  • The CCM can be successfully combined with a
    diseases management approach
  • Care patterns must be based on complexity of
    health problems and readiness of patients for
    self-management
  • The nature of chronic diseases, together with the
    upcoming shortage of staff, require a combined
    effort of all involved to develop powerful
    systems of self-management
  • Care standards based on CCM may function as a
    vehicle to start with a European variant of
    disease management
  • DM-organizations that mainly serve the interest
    of regional practitioners, may hinder the
    effectiveness and quality of chronic care in that
    region
  • -gt I thank you very much
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