CHRONIC ILLNESS

Overview

If the profiles in the following section make one thing clear, it is that health organizations are becoming more sophisticated and more diversified in their efforts to address the needs of patients with chronic conditions. Recent QI activities around asthma, diabetes, heart disease and overuse of antibiotics - not a chronic illness, but a chronic problem with long term implications - show a new intensity. Increasingly, measures are becoming more comprehensive, data sources are more varied, and interventions go beyond birthday reminders and patient newsletters (though these remain important).

Several themes emerge from these profiles. One reflects the growing role of the consumer in our health care system: patient involvement is a vital component of almost all of the activities. If patients did not begin to become active, participants in health care decisions and management of their chronic conditions, many of these efforts simply could not have succeeded.

And then, the system must provide support for the active patient. In the past, the system treated every patient with a similar diagnosis the same, and that may have led to the omission of necessary services. But the best of the QI efforts included here demonstrate mass customization - everyone get what everyone needs; individuals may get additional care and services as needed.

Finally, leadership - throughout the organization, but especially from clinical champions - remains a critical success factor. If anything, increasingly sophisticated and meaningful activities require stronger physician leadership than ever. But leadership must also come from the UM director, senior business managers and even outside vendors and agencies. Several of the profiles described such activities as local educational programs and healthy cooking contests at area restaurants. As always, health plans and providers - like their patients - are part of the communities they serve.