Sunday, December 19, 2010

Chronic Care Issues on the Rise

More than a quarter of Americans and two out of three older Americans have multiple chronic conditions with treatments accounting for 66 percents of the country’s healthcare budget. These numbers are expected to rise as the number older citizens rise in future years. As a result of these statistics, HHS has just issued their new “Strategic Framework on Multiple Chronic Conditions” a private-public sector collaborative venture.

Many initiatives, grants, and other actions are being taken at HHS to help improve health outcomes for patients with multiple chronic conditions. For example, AHRQ recently awarded more than $18 million in two grant categories. One grant program focuses on the research infrastructure needed to address the problem. The second grant program will compare how different strategies could be used to prevent and manage chronic illnesses with specific co-occurring conditions.

The HHS Administration on Aging and CMS jointly awarded $67 million in grants to support outreach activities to provide education, counseling, and assistance programs, plus funding was awarded to develop care transition programs to help improve health outcomes.

The HHS Assistant Secretary for Planning and Evaluation (ASPE) with funding obtained from an existing $40 million ASPE contract, awarded the National Quality Forum funds to develop and endorse a performance measurement framework for patients with multiple chronic conditions.

Both the FDA and ASPE are studying the extent to which individuals with multiple chronic conditions are being included or excluded from clinical trials for new therapeutic products and particularly from trials that are used as the regulatory basis for ensuring the delivery of safe and effective drugs for this specific population.

NIH is adding an older adult population to its original “Systolic Blood Pressure Intervention Trial” to determine whether obtaining a lower blood pressure range in the older population will reduce cardiovascular and kidney diseases, age-related cognitive decline, and dementia. For this project, NIH has committed $42.8 million to study these health issues.

The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $34 million in new funding to support the “Primary and Behavioral Healthcare Integration Program” (PBHCI) to promote the integration of care with people with co-occurring chronic conditions.

The funding is going to build partnerships and the infrastructure necessary for grantees to develop or expand their primary healthcare services with an emphasis on people with behavioral health problems. The “Center for Integrated Health Solution” funded by both SAMHSA and HRSA will provide training and technical assistance on the bidirectional integration of primary and behavioral healthcare.

American Indians and Alaska Natives are disproportionately affected by multiple chronic conditions and so the Indian Health Service has recently expanded their “Improving Patient Care Program” (IPC) to 100 sites across the IHS tribal and urban Indian Health system. The IPC program implements the patient-centered medical home model by developing training care teams, redesigning the health system, promoting self-care management, integrating behavioral healthcare into primary care, and improving the use of health technology.

CDC is supporting a new project “Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life”. This project with CDC funding will enable the Institute of Medicine to form a committee to examine the ongoing burden of multiple chronic conditions and what this means for possible population-based public health actions.

CDC has also funded a project to examine the impact of cognitive impairment on co-occurring chronic conditions. The project awarded to the University of Washington will be done with CDC’s “Health Aging Research Network”, to gather information to assist public health practitioners at local, state, and national levels in understanding the effects of cognitive impairment on chronic conditions. This will help researchers learn how to better design and how to better deliver evidence-based programs in spite of the increasing rates of cognitive impairment.