To Put It Together, First Take It Apart
It's little surprise that many of those who would try to make healthcare better are instead intimidated by it. After all, who could have to hubris to think they could "fix" the monolithic American Healthcare System? The leaders of the BIF | RISD Healthcare Innovation Project realized early on that in order to find ways to improve healthcare, even the subfield of primary care, they first needed to deconstruct it.
Although there is significant interest in "patient-centered care," it isn't always easy to tell who exactly the patient is. This is a critical factor since a patient's experience with their primary caregiver can vary radically, depending on which conditions or diseases he presents with.
"Though we're working to find a way to diagramming the scope and range of a typical experience, there are really several different conditions rather than a 'typical experience'." To make primary care more digestible, the team decided to create composite personas based on three types of healthcares that are provided by primary physicians: treatment for acute incidents, chronic conditions, and wellness and preventative medicine.
One team researched acute care, beginning their work by crafting a definition of the type of care. "It's care that is usually provided for a short period of time to treat a new illness, injury or a flare-up of an existing condition." Examples of acute care include heart attacks, diabetes complications, car accidents and high fever. Through their secondary research, the team was able to identify a host of issues relating to acute care: emergency department crowding, diversion of ambulances from overcrowded emergency rooms, uncompensated acute care, inadequate capacity to accommodate surges, insufficient supply of on-call specialists, and many other issues. "The problems in the health care system are magnified in the context of acute care." Three key systemic problem areas were spotted: lack of physical resources, poor allocation of funds, and overall lack of integration and organization. "Occurring simultaneously, these problems seem to compound and add to each others' failures, creating a setting of disorder and confusion."
Another team investigated chronic care, a vitally important type of care given the prevalence of chronic conditions in America: almost half of all Americans (133 million people) live with a chronic condition such as allergies, asthma, depression, diabetes or heart disease. As a result, "many managed care and integrated delivery systems have taken a great interest in correcting the many deficiencies in current management of chronic conditions." These deficiencies include rushed practitioners not following established practice guidelines, lack of care coordination, lack of active follow-up to ensure the best outcomes, and patients being inadequately trained to manage their illnesses. What areas present opportunities for improvement? The team identified six: "community-based programs, support for self-management programs, clinical information systems, identifying and implementing best practices, use of evidence-based protocols, and delivery system design."
The third team's investigation of well care brought them to issues that affect the daily routines of nearly all Americans and many (if not most) interactions between individuals and their primary care physicians. "Well care involves emotional health, nutrition, exercise, environmental risk factors, occupational hazards, family history and a range of other topics." Many of these issues also interact with chronic conditions, with fields like mental health, genetics and geriatrics bridging between the two types of care. Issues relating to wellness are broad, and therefore difficult to resolve: "it isn't just about diet and exercise."
All of this objective research provides a background and context for the interesting information - the experiences of patients and care providers in their daily relationships and interactions.
Posted November 22, 2006 02:34 PM by Allan Tear | Permalink
