Chronic medical conditions affect 125 million individuals in the United States [1]. These conditions are a major cause of disability and functional limitations. The frequency of such conditions rises exponentially with age, with 43 percent of Medicare beneficiaries having three or more chronic conditions [2]. By 2030, over 70 million baby boomers will have reached the ranks of the elderly, producing a dramatic demand for chronic disease care. Despite these trends, the American healthcare system has not developed the capacity to effectively care for chronic conditions. The focus remains on acute care and medical procedures, with little coordination among providers, wasteful duplication of diagnostic tests, and conflicting care plans. Moreover, the price tag for our healthcare system, as measured by per capita expenditures, is double that of other Western nations [3]. An urgent need exists to improve chronic disease care within the United States that will optimize care coordination, maximize outcomes, and lower costs. Multiple sclerosis (MS) is an example of a chronic disabling neurological disease requiring specialty care and coordination. In this discussion, MS is used as a model to examine both concerns and potential solutions for comprehensive chronic disease care. MS is the most common progressive neurological disorder of young adults, affecting 350,000 to 400,000 people in the United States [4]. The median age of onset is 30 years, an age when many are starting careers and families. MS most commonly presents with intermittent relapses and evolves to a progressive form. Common symptoms include weakness, sensory loss, disturbances of vision, ataxia, bladder dysfunction, cognitive deficits, and fatigue. Several medications have been developed to reduce disease morbidity and provide symptom relief. By 15 years from first symptom onset, 21 percent require a cane to walk [5]. This percentage increases to 69 percent by 40 years from onset. Because MS is a dynamic disease producing multifocal neurological deficits and disability, a wide range of healthcare specialists is required to assist in its management throughout the life of the patient. The neurologist is typically the principal caregiver, but referrals to rehabilitation specialists, psychologists, ophthalmologists, urologists, speech pathologists, wound specialists, and social workers are common. Multidisciplinary care is frequently promoted by MS advocacy groups within the United States. Yet, there have been few attempts to define MS multidisciplinary care models or test their effectiveness. Like other chronic conditions, coordination and continuity of care for patients with MS are often suboptimal. Jansen et al. recently evaluated the literature on integrated MS care [6]. Integrated care is defined as comprehensive in nature and coordinated between health and social care sectors to deliver seamless care to patients with multiple needs. The authors found several studies that documented significant unmet needs in patients with MS, the consequences, at least in part, of discontinuity and fragmentation of the healthcare system. Jansen et al. cited only two studies, both from Europe, that assessed integrative care initiatives across different healthcare settings for patients with MS [7-8]. Makepeace et al. used a multidisciplinary community team to deliver care to a group of MS patients [7]. A home-based care multidisciplinary team was the intervention deployed by Pozzilli et al. [8]. Both groups showed cost savings with their intervention. High patient satisfaction was noted by Makepeace et al., and quality of life measures improved significantly in the Pozzilli et al. study. Continuity of care and rigorous clinical outcomes were not assessed in these studies. Overall, there is potential for interdisciplinary care for MS care, but more research is needed to demonstrate overall utility. NEW MODELS FOR CHRONIC CARE What lessons can be learned from models of comprehensive care for other chronic diseases? …
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Feb 24, 2016
Donald Gardenier + 2
Open Access
