Preventive medicine: A cure for the healthcare crisis

Introductory Editorial: Few would dispute the premise that prevention, early detection, and early intervention form the first line of defense on the disease management (DM) continuum. That being the case, our national statistics on preventive health should be raising concerns throughout the industry. The US healthcare delivery system continues to fall woefully short of its prevention targets. On the international scene, the United States lags behind countries with less wealth and less technological savvy. Commentaries abound on the problems, but recently I became aware of an organization with an exciting goal and a novel solution for bringing preventive medicine into the mainstream. U.S. Preventive Medicine, Inc. (USPM) was founded by Christopher Fey, a former president and CEO of HealthCare USA, a multistate health maintenance organization, and senior officer of Coventry Health Care Corporation. A number of years ago, Mr. Fey had a life-altering experience. He witnessed his brother-in-law, a 39-year-old man in seemingly excellent physical condition, suffer a massive stroke that resulted in permanent right-sided paralysis, and speech and memory impairment. Following the event, physicians concluded that his brother-in-law’s risk factors could have been identified and his disease state detected by means of available technological screening devices. His was a condition for which effective drug therapy and other interventions were available. This event and its consequences were preventable. Having experienced firsthand the devastating consequences of a broken system that fails to respond until a condition produces symptoms, Mr. Fey became an evangelist for prevention and early detection. In founding USPM, he translated an interesting concept into an innovative model for preventive health in a consumer-driven market. In the following pages we provide a brief history of and current status report on the state of preventive health in the United States, and we present an overview of this company’s solution as one example of the untapped potential for innovation in the delivery of preventive services. I hope that the information contained herein will inspire you and our colleagues to join the conversation about the direction the United States will take with regard to improving access to screening and preventive services and enriching the lives of all citizens. As always, I welcome your comments. I can be reached at [email protected]

Report on the U.S. summit: Chronic care at the crossroads: Exploring solutions for chronic care management

On Tuesday, July 17, 2007 in Washington, DC, Intel Corporation assembled a group of the nation’s most respected health leaders to discuss the issues surrounding chronic care and an aging population and explore solutions to these highly complex and increasingly urgent challenges for the US health care system. The highlevel summit, hosted by Intel Chairman Craig Barrett, was held in the auditorium of the National Museum for Women in the Arts and attended, either in person or via the simultaneous webcast, by presidents, chairmen, and executive directors of influential organizations including the National Business Coalition on Health, the National Medical Association, and the Centers for Medicare and Medicaid Services (CMS). The summit was organized around 3 expert panels with representation from health care associations, health insurance companies, policy makers, advocates, providers and provider organizations, patient advocacy groups, and health technologies. Susan Dentzer, PBS\u27 on-air health correspondent (The NewsHour with Jim Lehrer), served as moderator. Highlights of the panel discussions follow

Embedding spiritual care into everyday nursing practice

This article explains how patients’ spiritual needs can be embedded into everyday nursing practice, rather than being seen as an additional task for nurses to undertake. It outlines an integrated person model of care, which involves the nurse using the unique contact involved in providing physical care to meet the patient's spiritual needs. In addition, nurses can use the principles of therapeutic relationships such as empathy and providing a non-judgemental presence to support spiritual care, as well as respecting patients' dignity and individuality. This article also describes techniques for discussing spirituality with patients, and explains how touch can be a useful therapeutic intervention that can enhance patients' spiritual well being

The effectiveness of heart failure disease management: Initial findings from a comprehensive program

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed after 1 year. The preliminary findings strengthen the case for comprehensive HF disease management as an effective means for improving clinical outcomes and reducing total medical costs for large patient populations

Evaluation of a comprehensive diabetes disease management program: Progress in the struggle for sustained behavior change

The successful management of diabetes with a goal of achieving near-normoglycemia requires patients to make multiple lifestyle changes as part of an intensive, complex, and coordinated therapeutic regimen aimed at reducing the risk of complications associated with the disease. The difficulty in creating and sustaining these lifestyle behavior changes is a major stumbling block in achieving the desired therapeutic goal. An underlying assumption of comprehensive disease management is that regular, personal contact with nurses and ancillary health professionals will facilitate these lifestyle behavior changes for program participants. The results of a survey of self-reported data from 750 participants in a comprehensive diabetes management program, reported on here, show strong perceptions of positive behavior change over the broad range of medical and lifestyle treatment areas associated with effective management of diabetes. These results suggest that diabetes disease management programs are an effective approach to helping diabetic patients accomplish the lifestyle behaviors critical to their health