Chronic illness care is an ongoing challenge in the health care system. More than 133 million Americans suffer from chronic illness and more than one-half have multiple chronic conditions. The cost of treating chronic diseases is estimated to be 6.8 percent of the gross domestic product.
As a member of the New Health Partnerships initiative (see article), The Joint Commission plans to work closely with the other 15 partners to improve outcomes for patients with chronic illnesses. Collaborative Self-Management Support is seen as a key to achieving this goal. According to the literature, CSMS strives to actively involve patients in the care process as equal partners and places a strong emphasis on patient-centered care and self-management. Ideally, all patients with chronic conditions are encouraged to have the confidence and skills to manage their care.
This assumption was supported by a recent survey The Joint Commission conducted of more than 1,400 disease management providers. The article on this page summarizes our findings. In addition, this topic will be covered at the Disease-Specific Care Conference in September (see registration details). Other topics include the business case for disease-specific care and performance measurement methods. It promises to be an interesting conference. I hope you can join us.
Jean Range, MS, RN, CPHQ
-Top-
The Joint Commission has been invited to participate in New Health Partnerships, a national initiative designed to improve the care provided to patients with chronic illnesses through the use of Collaborative Self-Management Support techniques.
The IHI has invited 16 organizations to serve as “key partners” to promote the broad adoption of CSMS. The NHP Initiative aims to:
- Target patients with chronic conditions.
- Improve care quality.
- Reduce the cost of providing care through patient-centered collaborative self-management support.
“As a key partner in the New Health Partnerships Initiative, The Joint Commission’s Disease-Specific Care Certification Program will work to increase the awareness of CSMS and support the goals of the program,” says Jean Range, executive director, Disease-Specific Care Certification. “The Joint Commission has already conducted a survey on CSMS that identifies a number of areas for follow-up activities.” (See article.)
The initiative is overseen by the Institute for Healthcare Improvement and funded by the Robert Wood Johnson Foundation. For more information, go to www.newhealthpartnerships.org.
-Top-
A survey of more than 1,400 disease management organizations and providers shows that 88 percent are using self-management techniques to help chronically ill patients improve their care. Of those using these techniques, collaborative decision making was used by 92 percent, followed by information giving/closing-the-loop at 90 percent; goal setting at 87 percent; and information-giving only at 70 percent. (See below for a description of these techniques.)
“The goal of the study was to find out what self-management approaches were being used, their frequency and how they affected patient outcomes,” says Jean Range, executive director, Disease-Specific Care Certification. “Our respondents indicated that self management support has resulted in greater patient satisfaction, increased adherence to treatment plans and improved outcomes.”
Findings
- The top disease states managed by the respondents included diabetes, heart failure, chronic obstructive pulmonary disease, coronary artery disease, asthma, obesity/weight management, depression, oncology, chronic kidney disease, high risk obstetrics, and neonatology/prematurity.
- Collaborative decision-making is used more than any other technique.
- Self-management techniques were used mostly by provider and disease management firms, while those enrolled in the national diabetes initiative were more likely to use motivational interviewing.
- Providers rely on clinical and functional outcomes to measure success while disease management firms use financial outcomes.
- The majority of providers were hospitals, followed by home health and behavioral health.
- The majority of purchasers were health plans followed by Medicare and Medicaid.
Information on the survey will be presented at the Disease-Specific Care Fall Conference, Sept. 26, in Oakbrook Terrace, Ill. (See related registration details.)
|
Self-management support strategies* |
|
Information-giving only: The traditional approach. The patient is passive and told what to do.
Information-giving/closing-the-loop: Patient is asked to restate information to assess their understanding of new information.
Collaborative decision-making: Patients participate in decisions about their care. They accept responsibility to manage their own conditions with information, not orders, from their physicians.
Goal-setting: An interaction between caregiver and patient resulting in the patient agreeing to a concrete, usually short-term goal.
Motivational interviewing: Use of directed questions and reflective listening to encourage the patient to participate. Ideally, the patient will present the argument for change.
*Bodenheimer, et al, http://www.chcf.org/ |
-Top-
The Centers for Medicare & Medicaid Services has announced that Ventricular Assist Devices programs currently Medicare-approved have until March 27, 2009, to become certified by The Joint Commission under the Disease-Specific Certification Program for VAD.
Requirements
To be eligible for certification, the hospital’s VAD program must include a board-certified cardiac surgeon who has placed 10 VADs in the last 36 months with current activity in the last year. If a surgeon on the team has not placed 10 VADs during the required time period, the volume requirement can be met by including artificial heart placements for no more than 50 percent of the total volume.
The standards will cover:
- Delivering or facilitating clinical care
- Performance measurement
- Supporting self-management
- Program management
- Clinical information management
Certification will be valid for two years. There will be a performance measurement requirement on the one year anniversary of the certification. The complete requirements are available online. For more information, contact M.J. Hampel, associate director, at mhampel@jointcommission.org or (630) 792-5720.
-Top-
The Joint Commission is conducting a field assessment for the Management of Patients with Chronic Obstructive Pulmonary Disease. To participate, click here. The deadline for comments is June 5, 2007.
-Top-
Effective July 1, 2007, new performance measurement requirements will be implemented for all certified programs. See the requirements.
-Top-
If your organization has multiple sites but only some are certified by The Joint Commission, you must make a clear distinction between the certified and non-certified sites in marketing and other communications.
For instance, if ABC Health Care System has three stroke centers, but only Hospital A has a certified stroke center, the health care system cannot refer to all of its stroke centers as “certified.” Instead, it could refer to its certified stroke center as “Hospital A Stroke Center, which has earned the Gold Seal of Approval™ from The Joint Commission for Primary Stroke Centers.” This clear distinction avoids false advertisement of certification that has not been achieved.
For more information on marketing and publicizing your certification award, see the free online publicity kit.
-Top-
Members of the DSC staff attend meetings and conferences throughout the year. In 2007 we’ll be at:
- June 19-23, Case Management Society of America, Denver, CO.
- June 22-26, American Diabetes Association, Chicago, Ill.
- August 2-4, American Association of Diabetes Educators, St. Louis, Mo.
- Sept. 9-12, National Association for Healthcare Quality, Boston, Mass.
- Sept. 16-19, Disease Management Association of America, Las Vegas, Nev.
-Top-
- Disease-Specific Care Certification (630) 792-5291
- Standards Interpretation Group (630) 792-5900
- DSC Account Representative (630) 792-3007
- Customer Service (630) 792-5800
- Pricing Unit (630) 792-5115
-Top-
For information or to order products from Joint Commission Resources, Inc., go to www.jcrinc.com/Infomart.htm or call (877) 223-6866.
Education
New! Disease-Specific Care Fall Conference
This one-day conference will help you build a business case to initiate a DSC program; assess information from case studies to improve an existing program; integrate current theories of disease self-management into your program; and evaluate performance measures.
- Sept. 26, Oakbrook Terrace, Ill.
2007 Disease-Specific Care Certification Workshop
Covers the DSC certification process, standards, clinical practice guidelines, and performance measurement expectations.
- June 19, Oakbrook Terrace, Ill.
- Sept. 19, Garden Grove, Calif.
Publications
Disease-Specific Care Certification Manual
Order code: DSCC02SJ, $75
Disease-Specific Care Certification Toolkit
Helps DSC programs prepare for Joint Commission certification, comply with standards, collect and analyze data, and effectively use outcomes measures to improve care.
Order code: DSCD03SJ, $60
NEW! Know Your Rights
This new Speak Up™ patient safety brochure has questions and answers to help patients find out about their rights as a patient and make better decisions about their care.
Order code: SPKBRKYR-07, $25 for pack of 100
Acting Locally: Working in Clinical Microsystems CD-ROM
Discusses microsystem-based improvement efforts, including leadership, culture, patient focus, staff focus, patient safety, performance improvement and information technology.
Order code: WCM06SJ, $60
-Top-