Adults with 1+ Chronic Condition(s)
Interventions to improve healthcare outcomes and reduce costs among European and other Western patients with chronic disease such as diabetes and COPD have been the subject of numerous papers, though clear-cut examples of successes are more difficult to identify. Among these are improving the health literacy of the general population, programs to actively promote healthy lifestyles, immunization programs, collaborative care, giving the primary care physician more control in long-term care, using primary care physicians as gatekeepers to hospital care, and using IT solutions to improve the transition from the hospital to the home. Details of these have been entered into the project spreadsheet and duplicated with in-line citations below.
- Improving Health Literacy (Educating communities about healthcare and wellness not only decreases the likelihood of developing many chronic diseases, but also enables those with chronic diseases to self-manage disease, with just 45 minutes of patient instruction "significantly improving" patient self-monitoring, active engagement in life, and emotional well-being after 3 weeks.)
- Health Promotion (Programs to actively encourage citizens to adopt healthy lifestyles — e.g., giving up smoking, losing weight — not only decrease the chances of developing chronic diseases, but in some trials can actually help put some chronic diseases, such as diabetes, into remission.)
- Immunization (It is estimated that if all European countries had hit their target of vaccinating 75% of their "at risk" citizens against the flu, 9,000-14,000 lives would be saved each year, many of whom are elderly or have chronic conditions which compromise their immune systems).
- Collaborative Care (The management of chronic conditions such as depressive disorders or heart failure show marked improvement when interventions are based in the community, nurses are involved as case managers, and/or the interventions incorporate a multidisciplinary team approach; e.g., one recent study showed that depression patients receiving intervention were 0.23 points lower on the Hopkins Symptom Checklist score for measuring depression severity.)
- Centering on the PCP (In the Netherlands, care of chronic conditions is reimbursed in a fixed budget, negotiated by a care group led by the patient's primary care physician, who "is responsible for the full spectrum of care-related activities," reducing fragmentation in the patient's care in favor of integrating different providers and channels.)
- Primary Care Gatekeeping (Countries with a "lack of a formal gatekeeping role" by primary care physicians see more hospital admissions for conditions "amenable to management in primary care"; e.g., Germany sees 216 admissions per 100,000 for diabetes compared to the Netherlands' 68 per 100,000.)
- Improved Primary Care Access (Emergency Departments (EDs) are frequently visited by patients with chronic illnesses due to complaints that would be better seen in primary care; Britain's NHS created a non-emergency health number (111, as opposed to the emergency number 999) to provide sufficient access to primary care physicians 24/365. A survey of the callers found that only 17% needed emergency care, reducing ED caseloads accordingly.)
- IT Hospital-to-Home Care (Odense University Hospital in Denmark used advanced IT solutions "to facilitate high quality hospital-to-home care," such as providing COPD patients with home-monitoring "briefcases," which reduced their average hospital stay from the European average of 7 days to just 2.9 days. More recent papers have confirmed the effectiveness of Odense's e-consult system.)
While initial research demonstrated that there were numerous academic, government, and other authoritative sources discussing the impact of various health interventions in Europe and around the world, we also found that such reports tended to be focused on single interventions or, at most two or three interventions compared. Since attempting to collate data from literally thousands of papers and articles would take us well outside of the scope for a single Wonder request and might result in scattershot results (i.e., we would lack clear criteria for determining the relative impact of each intervention), we stepped outside of academic works in the hopes of finding a more comprehensive overview.
This led us to a 2016 report by the Deloitte Centre for Health Solutions entitled "Vital Signs: How to deliver better healthcare across Europe." While we nominally try to restrict ourselves to sources published within the last two years, the long publication cycles in academic and government works sometimes precludes this, and we could find no comparable report that had been published more recently in the public domain. The Deloitte report contains numerous interventions, many (though not all) with at least tacit impact metrics and links to other sources. Therefore, we used the Deloitte report as the skeleton of our own, searching for more recent outcome data for each intervention to flesh it out with the most up-to-date information publicly available.
We also located a second guide in the form of a monograph published by the WHO entitled "Assessing chronic disease management in European health systems." While this monograph provided guidance to our research, it contained little in the way of hard success metrics, and so was used primarily as a guide to other resources.
With those as our primary guides, we pulled relevant studies and used Google's Scholar database to find out which other academic works had cited them. This enabled us to quickly determine whether there had been any follow-up studies with more recent data and analysis. In all cases, we have cited the most recent publicly-available data.
In some cases, in order to fulfill the criterion that we focus on adults with at least one chronic health condition, we had to use the Deloitte paper as a jumping-off point. For example, noting that COPD resulted in a disproportionate number of (possibly) unnecessary hospitalizations, we looked for further studies on interventions in COPD. While we made Europe our first focus, we have included intervention studies from abroad when these proved best suited to the project.
As a final note, the distinction between primary prevention and secondary as given in the project criteria was somewhat problematic given that the project specs specifically enjoin us to look for interventions with patients who have at least one chronic condition. Within this context, therefore, we understand primary interventions to be those intended to prevent the worsening of existent chronic diseases and to encourage overall heath via population-level interventions. Secondary prevention we understand to involve treating the disease once it becomes symptomatic.
Where possible, we have focused on broad intervention trends rather than those specific to particular diseases, but in some cases focusing on specific diseases was necessary to provide measurable impact statistics. Likewise, we have given preference to hard data whenever it is available, but many of the publicly-available reports only provide generalities (e.g., "significant improvement"), sometimes with statistical significance numbers, sometimes not.