Complex Chronic Care Research Articles

Heeding Our Words: Complexities of Research Among Low-Literacy Populations

Melissa A. Simon, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine; and Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL XinQi Dong, Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL Narissa Nonzee and Charles L. Bennett, Division of Hematology/Oncology, Department of Internal Medicine, Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL

Interview with a Quality Leader: Kevin B. Weiss on Measures in the Ambulatory Setting

Kevin B. Weiss, MD MPH, joined the American Board of Medical Specialties as president and chief executive officer in December 2007. He also is a clinical professor of medicine in the Division of General Medicine at Northwestern University's Feinberg School of Medicine, Chicago, IL. He formerly served as director of the Institute for Healthcare Studies and of the Center for Management of Complex Chronic Care at Hines and Chicago Veterans Administration medical centers. For more than 20 years, Weiss has devoted his medical career to quality and access issues in primary care, conducting epidemiological and health services research projects related to guideline implementation, chronic care management, outcomes measurement, and quality improvement, with an emphasis on asthma. Recognizing the importance of patient safety and quality of care in his community, he also helped found the Chicago Patient Safety Forum and served as its first chairperson. Weiss currently serves on the Clinical Performance Measures Committee of the National Committee for Quality Assurance and represents the American College of Physicians (ACP) at the National Quality Forum (NQF) and the American Medical Association's Physicians Consortium for Performance Improvement. He also serves on NQF's Consensus Standards Approval Committee and chairs AQA's Performance Measures Committee. Weiss is also an ACP Board of Regents member. He completed his medical degree at Chicago Medical School and master's degrees in community health sciences at the University of Illinois at Chicago School of Public Health and in health services administration at the Harvard School of Public Health, Boston, MA. He is certified by the American Board of Internal Medicine.

Complex chronic care: Patient, provider and organisational issues

AbstractWith the ageing population and therapeutic advances in acute and chronic disease treatment, more patients are living with at least one chronic condition. The management of a patient's chronic condition is complicated by the simultaneous presence of multiple competing comorbidities and the intrapersonal and external factors that influence chronic care. The current US healthcare system is largely organised around the management of acute illness and as a result is struggling to meet the challenges of complex chronic care. These challenges require innovative strategies to improve patient care and clinical outcomes. This paper explores some of the challenges faced by patients, healthcare providers and healthcare systems, and reviews new avenues of health services research that target these challenges.

Complex chronic care: Patient, provider and organisational issues

Complex chronic care: Patient, provider and organisational issues

Managing Patient and System Complexities to Improve the Quality and Outcomes of Chronic Care

It is estimated that more than 120 million people in the United States have a chronic health condition, and 24% of those have three or more conditions.1 Overall, the veteran population is sicker and older than the general population, and a large proportion suffer from one or more chronic illnesses. For example, type 2 diabetes affects nearly 20% of veterans; ischemic heart disease is the most frequent indication for hospitalization in the VA; depression and schizophrenia account for more than 25% of VA’s total healthcare costs; and VA is the largest single provider of HIV care in the United States. Moreover, VA is now caring for a new generation of veterans who served during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Many of these veterans have suffered polytraumatic (multi-system/multi-organ) injuries, including traumatic brain injury and loss of limbs. These new veterans present our health care system with new challenges in terms of managing complex chronic care. Not only must VA provide the best care possible for veterans with multiple injuries, we also must help these young veterans learn to cope and live with chronic illness. The challenge to VA and other health care organizations is how best to serve patients with complex chronic care needs. Treating multiple chronic illnesses can be particularly difficult given that clinical guidelines are tailored to individual illnesses, and specialized care may involve multiple providers that need to work together to provide patient-centered, coordinated care. To further our understanding of the many issues surrounding chronic care, in 2006 VA’s Office of Research and Development Service (ORD) hosted a state-of-the-art (SOTA) conference on “Managing Complexity in Chronic Care.” A multidisciplinary group of more than 80 VA and non-VA policymakers, researchers, managers, and clinicians came together at this invitation-only conference to synthesize the state of the art for managing complex care from the perspective of the patients, providers, and health care system—and to identify what we know and what we need to know about this imperative health care issue. Specific conference goals included: Developing policy recommendations to assist VA and the larger health care community in their efforts to improve clinical care models and the management of patients with chronic illnesses, and Developing a research agenda that will address the current knowledge gaps in managing complex chronic care. The SOTA planning committee, chaired by Kevin Weiss, MD, MPH, Director of VA’s Center for Management of Complex Chronic Care, developed the conference agenda and commissioned papers as background providing participants with a common knowledge base to stimulate discussion. These background papers were further refined after the SOTA and are the basis of this supplement, along with several other manuscripts that were developed as a result of the SOTA deliberations. Papers address topics such as self-management in complex chronic diseases, prevalence, health consequences, and implications for quality, care management, and costs for persons with multiple chronic conditions, and information technology to support improved health care for those with chronic illnesses. I would like to thank Dr. Weiss, members of the SOTA planning committee, authors of the excellent articles included in this Supplement, and all conference participants for their expertise and dedication to identifying evidence-based strategies for managing complexity in chronic care. In addition to this Supplement, SOTA participants outlined on a research agenda that will generate knowledge to help VA provide the best possible care to thousands of veterans dealing with chronic illness. Over the last decade, VA ORD’s Health Services Research & Development Service has facilitated eight state-of-the-art conferences that have covered a range of topics vital to improving the health and health care of our veterans and the nation, i.e., leading organizational transformation, long-term care, informed consent, and implementing research evidence into practice. In the future, we plan to hold another SOTA that will focus on issues surrounding the care of OIF and OEF veterans.

Managing Complexity in Chronic Care: An overview of the VA State-of-the-Art (SOTA) Conference

IntroductionThe aging of the population and the increasing prevalence of multiple chronic illnesses, along with multiplying options for clinical management, pose great challenges to both the Veterans Health Administration (VHA) and the broader US health care system. Developing effective and efficient health care for persons with complex and multiple medical conditions is a national priority. Therefore, research in this area is critically important. In 2006, the VHA Health Services Research and Development Service held a state-of-the-Art (SOTA) conference titled “Managing Complexity in Chronic Care” to clarify our current understanding of the management of complex chronic conditions and suggest directions for research to better address this important problem.ObjectiveThis article provides an overview of the major findings from that conference, including major presentations, summaries of the workgroup deliberations, and a list of research topics that were thought to be of highest importance to advancing our ability to provide medical care for persons with complex chronic care needs.

The Sound and the Fury: Financial Conflicts of Interest in Oncology

Benjamin Djulbegovic, H. Lee Moffitt Cancer Center & Research Institute and the Department of Interdisciplinary Oncology, University of South Florida, Tampa, FL Cara Angelotta and Kjersti E. Knox, Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL Charles L. Bennett, Division of Hematology/Oncology, Department of Medicine, Northwestern University University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center; Jesse Brown Veterans Affairs Medical Center; and the Veterans Affairs Center for Management of Complex Chronic Care, Chicago, IL

Supporting self-management for patients with complex medical needs: recommendations of a working group

Increasing numbers of persons live with complex chronic medical needs and are at risk for poor health outcomes. These patients require unique self-management support, as they must manage many, often interacting, tasks. As part of a conference on Managing Complexity in Chronic Care sponsored by the Department of Veterans Affairs, a working group was convened to consider self-management issues specific to complex chronic care. In this paper, we assess gaps in current knowledge on self-management support relevant to this population, report on the recommendations of our working group, and discuss directions for future study. We conclude that this population requires specialized, multidimensional self-management support to achieve a range of patient-centred goals. New technologies and models of care delivery may provide opportunities to develop this support. Validation and quantification of these processes will require the development of performance measures that reflect the needs of this population, and research to prove effectiveness.