Assessing chronic disease management in European health systems. Concepts and approaches

This book comprises two volumes and builds on the findings of the DISMEVAL project (Developing and validating DISease Management EVALuation methods for European health care systems), funded under the European Union’s (EU) Seventh Framework Programme (FP7) (Agreement no. 223277). DISMEVAL was a three-year European collaborative project conducted between 2009 and 2011. It contributed to developing new research methods and generating the evidence base to inform decision-making in the field of chronic disease management evaluation (www.dismeval.eu). In this book, we report on the findings of the project’s first phase, capturing the diverse range of contexts in which new approaches to chronic care are being implemented and evaluating the outcomes of these initiatives using an explicit comparative approach and a unified assessment framework. In this first volume, we describe the range of approaches to chronic care adopted in 12 European countries. By reflecting on the facilitators and barriers to implementation, we aim to provide policy-makers and practitioners with a portfolio of options to advance chronic care approaches in a given policy context. In volume II (available online at http://www.euro.who.int/en/about-us/ partners/observatory/studies), we present detailed overviews of each of the 12 countries reviewed for this work and which informed the overview presented in the first volume of the book

Assessing chronic disease management in European health systems. Country reports

Many countries are exploring innovative approaches to redesign delivery systems to provide appropriate support to people with long-standing health problems. Central to these efforts to enhance chronic care are approaches that seek to better bridge the boundaries between professions, providers and institutions, but, as this study clearly demonstrates, countries have adopted differing strategies to design and implement such approaches. This book systematically examines experiences of 12 countries in Europe, using an explicit comparative approach and a unified framework for assessment to better understand the diverse range of contexts in which new approaches to chronic care are being implemented, and to evaluate the outcomes of these initiatives. The study focuses in on the content of these new models, which are frequently applied from different disciplinary and professional perspectives and associated with different goals and does so through analyzing approaches to self-management support, service delivery design and decision-support strategies, financing, availability and access. Significantly, it also illustrates the challenges faced by individual patients as they pass through the system. This book complements the earlier published study Assessing Chronic Disease Management in European Health Systems; it builds on the findings of the DISMEVAL project (Developing and validating DISease Management EVALuation methods for European health care systems), led by RAND Europe and funded under the European Union’s (EU) Seventh Framework Programme (FP7) (Agreement no. 223277)

Maternal Kronik Hastalık ve Enfeksiyon ile Otizm Spektrum Bozukluğu Olan Çocuğa Sahip Olma Arasındaki İlişki

Objective: The aim of the study was to evaluate the relationship between prenatal chronic diseases, infection, and autism spectrum disorder. Material and Method: Retrospective, cross-sectional and comparative research design was used. The sample was conducted with 99 mothers for the group, 44 of whom had a child with autism spectrum disorder and 55 of whom had a child with non-autism spectrum disorder. Data were collected from mothers between October 2020 and January 2021 via online methods (Facebook, Whatsapp, and Instagram). The study data was collected with a questionnaire form and the Childhood Autism Rating Scale. Results: It was determined that autism spectrum disorder was more common in the children of mothers with maternal diabetes (χ²= 5.196; p= 0.023) and infection (χ²= 5.331; p= 0.021). Gender, low birth weight, and twin pregnancy were also found to be risk factors for autism (p<0.05). Conclusion: As a result, the data obtained show that chronic diseases and infection of the mother in the prenatal period increase the risk of autism in the child. Therefore, in the presence of diseases such as maternal diabetes and infections, the mother and fetus should be monitored, and children with autism spectrum disorders should be detected at an early stag

Workplace Wellness Programs: Are They Part of the Answer to the U.S.’s Growing Healthcare Crisis?

[Excerpt] Of the $2.8 trillion that the United States has spent on healthcare in recent years, the majority of it (75%) is spent treating chronic disease. Chronic disease is “a long-standing condition that can be controlled but not cured… It is the leading cause of death and disability in the U.S., which is 1.7 million lives each year.” To make matters worse, chronic disease indicators in the U.S. have been on the increase recently. And, even though chronic disease is commonly thought to be more prevalent among the elderly, in the past 10 years, it has increased by 25% among working-age adults. The cost of chronic disease to the U.S. economy far exceeds the money and resources spent to treat it. In fact, a study by the Milken Institute found that the indirect costs of chronic diseases (such as missed days from work) are higher than the direct costs to treat them. Furthermore, a study by PricewaterhouseCoopers found that these indirect costs are four times higher for individuals with chronic disease than for those without them. Therefore, chronic disease is strongly affecting employers’ increasing healthcare expenditure. A joint study by Tower Watson and the National Business Group on Health found that 67% of employers identified employee’s poor health habits as one of their top three challenges to maintain affordable health coverage

Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group.

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option