Rethinking the Future of Outpatient Chronic Care

Janice Simmons, for HealthLeaders Media , September 13, 2010
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"The reason we make those distinctions is that they require different levels of intervention," he says. In the current medical model, hypertensive patients often fail to make a physician appointment or no one keeps in touch with them between physician visits. This model is cheap now—when care is delayed or nonexistent—but can rapidly inflate as time goes on.

Instead, if efforts are made to provide care at the appropriate intervals and make sure conditions are monitored, patients' conditions will be prevented from deteriorating. In the average practice, about 40% to 50% of patients have their high blood pressure under control. Using a proactive approach, that rate can rise up to 80%.

That improvement translates into fewer strokes and heart attacks. Using mathematical projections, Jirjis has predicted that in a group of 10,000 hypertensive patients, approximately 37 to 40 fewer heart attacks or strokes would occur over a five-year period, translating into several million of savings during that time.

These savings could be plowed back into the practice to help supply other providers, including nurses or physician assistants, to provide ongoing care. "We should be able to double our capacity of patients," Jirjis says.
Self-management is an area that could receive additional attention among the chronically ill population, according to Shirley Moore, PhD, RN, a professor of nursing at Case Western Reserve University in Cleveland, and director of its Self-Management Advancement through Research and Translation Center.

"Promoting self-management of health?can have some great downstream effects in terms of mitigating problems with chronic illnesses," she says.

"Medication adherence is a huge area" that could benefit populations with multiple chronic illnesses because of the number of medications they are on, she says.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
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