Mark Lewandowski continued his podcast commentary by addressing the trend of moving toward comprehensive chronic care management (3:00-6:00). He explains that the term “comprehensive” really refers to a global attempt to care for ALL the needs of the patient with a “care-in-place” program where ever that place may be. It could be, and most often is, in the patient’s home, or that of a close relative. But, it may also be in an extended care facility such as a nursing home, assisted living facility, a rehab center or some other non-acute care setting. In any case, such care requires that of:
- A physician
- A qualified clinician
- Community members
The physician is, obviously, needed to periodically assess the patient’s condition and develop the care plan. The clinician provides the care, implementing the plan. The family members are there to help with the care and provide emotional support. And the community members are important to provide social support.
Mark is clear in noting that the patient is more than a chronic condition. The patient is a social being suffering, not only from an unrelenting physical (medical) condition but also from end-of-life psychological challenges. A being who needs to be able to be out and socialize. When patients are homebound, they can no longer go to the waiting room in the doctor’s office or go to church or other social events. Yet they still need opportunities for socialization.
The term “chronic” generally refers to a condition that is more than a year in duration. It is long-standing, with an unremitting and progressive advancement of the disease, resulting in progressive deterioration of the patient. In addition, with the continued deterioration of the patient’s condition, additional disorders may occur which create comorbidity.
In this context, the term “care” really relates to “care-in-place”, meaning that it is where the patient normally lives and not in an acute care facility. Mark makes the point that this concept is extremely important considering the fact that 11% of the population account for nearly 50% of healthcare spend.