Healthcare Access in America

Healthcare access is a challenge in the US healthcare system despite great strides on many fronts. For instance, patients experiencing multiple chronic conditions have problems of accessing quality treatment. Their problems are not only limited to specialty care but also primary care due to high costs and the shortage of caregivers. Hospital providers lack policies to deal with multiple chronic conditions due to unavailability of proper guidelines on the same.  Therefore, the clinical outcomes of patients with multiple chronic conditions are low due to the poor quality of care. However, the Agency for Healthcare Research and Quality(AHRQ) is improving the situation through the provision of data through consumer health information technology to inform guidelines on multiple chronic conditions. Moreover, the agency is funding programs by offering grants to organizations to conduct research on improving clinical outcomes of patients with multiple chronic conditions

Key words: Agency for Healthcare Research and Quality, consumer health information technology, multiple chronic conditions, quality of care, access to health services, caregivers, specialty care, primary care

Introduction

Agency for Healthcare Research and Quality is an independent agency within the US Department of Health and Human Services (AHRQ, 2017). The organization is tasked with improving the US healthcare system through provision of health services that are more accessible, affordable, of higher quality, equitable and safe informed by evidence (AHRQ, 2017). The high prevalence of individuals with Multiple Chronic Conditions (MCC) in the population particularly for older citizens is becoming a serious public health issue (Parekh & Goodman, 2013). MCC is responsible for the increase in healthcare costs and overall financial burden on Americans (Parekh & Goodman, 2013; AHRQ, 2015). The statics of MCC in America are worrying. According to Parekh et al.(2011), one in every four Americans suffers from multiple chronic conditions. Therefore, the Department of Health and Human Services through AHRQ developed a strategic plan for combating multiple chronic conditions (Palekh & Goodman, 2013). To improve patient care for those with various chronic conditions through evidenced research, AHRQ provides grants to organizations to study the problem (AHRQ, 2015a).  The funded programs conduct research to overcome challenges associated with MCC by focusing on the use of information technology and scope of care (AHRQ, 2015). One such program is the understanding and honouring patients with Multiple Chronic Conditions in 2014 (AHRQ, 2015b).
The purpose of this assignment is to examine health care access in America by exploring a program fully approved and funded by the Agency for Healthcare Research and Quality.

Mission and budget

Understanding and honoring patients with multiple chronic conditions is a fully funded program by AHRQ under the Group Health Cooperative (AHRQ, 2015a). The program is funded through the understanding user needs and contexts to inform consumer health information technology  (RO1)(AHRQ, 2015a). The plan was given grants under the AHRQ MCC Research Networks to offer funding to organizations with large data capability to conduct research.(AHRQ, 2015b). The chosen agencies were to provide information to healthcare professionals for evidence-based practice to improve clinical outcomes for patients suffering from MCC (AHRQ, 2015b).

The program's mission is to improve the needs of individuals suffering from multiple chronic conditions to overcome the challenges of the disease and increase their quality of life. The program was implemented in Seattle, Washington State and covers individuals with chronic conditions in the population in all care settings with a focus on primary and speciality care (AHRQ, 2015a). The program was funded to a tune of $1,488,746 over a span of 3years to end in 2017(AHRQ, 2015a).

Strategic plan of the program

The strategic plan of understanding and honouring patients with MCC is based on a framework developed by the department of health on chronic conditions (Parekh & Goodman, 2013). The plan focuses on filling the existing knowledge gaps on and interventions for the benefit of individuals living with MCCs (Parekh & Goodman, 2013). The difference in knowledge involves lack of proper understanding of priorities of people with MCC, the impact of health information technology in improving quality of care for MCC and ways in which patients can communicate their needs to health providers(AHRQ, 2015a; Lim et al., 2017). The program aims to improve the lives of individuals with MCC by establishing a priority plan and also engaging caregivers and healthcare providers on how to implement the plan (AHRQ, 2015a). The strategic plan for honouring people with MCC is based on the following four significant goals;

• Foster healthcare and public health systems changes to improve the health of individuals with MCC (Parekh & Goodman, 2013; Parekh et al., 2011)
• Maximize the use of proven self-care management and other services with individuals with MCC (Palekh & Goodman, 2013; Palekh et al., 2011).
• Provide better tools and information and information to healthcare, public health and social services workers who deliver care to people with MCC(Parekh & Goodman, 2013; Parekh et al., 2011)
• Facilitate research to fill knowledge gaps about, and interventions and systems to benefit individuals with MCC (Parekh & Goodman, 2013; Parekh et al., 2011)

Quality of healthcare

Controlling of quality of care for multimorbidity involving MCC can be quite challenging (Zulman et al.2014). The inability to understand the priorities means that patients receive a low quality of care as their needs are not met (Lim et al., 2017). To improve quality of care, understanding and honouring patients with MCC will engage with both primary and speciality caregivers to ensure their priorities are met (AHRQ, 2015a). The inability for healthcare providers to identify the interrelatedness of the various chronic conditions affecting an individual leads to poor quality of care as the treatment regimen is not holistic. For instance, a patient suffering from depression or chronic pain may receive little or no treatment regarding coronary heart diseases, diabetes or hypertension (Zulman et al., 2014). Therefore, finding the interrelatedness of multimorbidity is the best way to the enhanced quality of care for MCC (Zulman et al., 2014). That can only be achieved through the use of health information technology such as Electronic Health Records that point to the development of chronic conditions for a particular patient.

Costs of healthcare

Having a single chronic disease is enough financial burdens to send most patients to economic ruin. However, multiple chronic conditions are a whole new level with severe consequences for medical costs. Therefore, containing the costs associated with MCC is difficult even for health policymakers. The low quality of life related to patients with multiple chronic conditions makes them less economically productive (Zuiman et al., 2014). The total healthcare expenses for an individual with MCC is quite high as a result of more prescriptions, home-visits, hospitalization and physician visits (Zulman et al., 2014). Understanding and honouring individuals with MCC program controls costs by exploring ways of helping them communicate their needs to healthcare providers. For instance, a patient suffering from chronic pain, mental illness and diabetes may want the chronic pain handled first to reduce medical expenses. Furthermore, having the ability to start treatment regimens for individual chronic diseases early in life may be helping in avoiding the huge medical cost burden later in life.

Alignment with healthcare professionals

The program is much aligned with a healthcare professional who is concerned about the clinical outcomes of patients with MCC. Mortality rates among patients with multiple chronic conditions are very high. Healthcare professional dealing in primary care may develop the great interest in the program as it will help them understand their patients better. Other professionals in health information technology may also find the program interesting because it examines ways of incorporating IT in determines risk and burden of MCC (AHRQ, 2015a). The inclusion of emergency ambulatory care brings in a trauma perspective for physicians handling MCC patients. Specialty care in coronary heart disease, diabetes, chronic pain, mental and behavioural health, hypertension and others are also covered.

Is the program valuable or the waste of taxpayer funds?

I think the program is precious to both patients and healthcare professionals involved in multiple chronic conditions. Through the AHRQ, the program can be used to collect data that informs policy decisions and offer evidence-based guidelines for clinicians and patients in America (AHRQ, 2015b). Furthermore, the majority of the one in four Americans affected MCC is above the age of 50 (AHRQ, 2015b; Parekh et al., 2011). The situation is worse because the ageing population in the world is growing at a steady pace. If the current circumstances are not controlled, America will have a significant number of people suffering from multiple chronic conditions. In fact, the program should be given more funds because the existing knowledge gap in MCC is huge and the consequences are adverse (AHRQ, 2015a; Lim et al., 2017). Furthermore, the majority of caregivers such as nurses and physicians when treating chronic conditions rarely consider MCC because the existing guidelines are inadequate (Parekh et al. 2011). The program will look gather data on how MCC can be included in the diagnosis and treatment of chronic conditions by health care professionals (Parekh et al., 2011).

The program is beneficial because it is providing information about the healthcare costs associated with MCC. Statistics show that multiple chronic conditions account for approximately 66% of the healthcare costs in the US (AHRQ, 2015b). The result is that Americans with multiple chronic diseases spend the considerable portion of their income on medical services. High consumer health spending has a negative impact on other sectors of the economy(Zulman et al., 2014). Patients with MCC also spend a lot of resources from their pocket to foot medical bills that cannot be covered by insurance. However, if the policy healthcare can develop a system that allows patients and healthcare organizations to save expenses, the financial burden of MCC will also significantly decrease. Quality of care is the foundation of healthcare access and the program has the capacity to improve it for the benefit of both patients and physicians. The program's method of visiting homes and interviewing those suffering from MCC is crucial in developing self-care management techniques (AHRQ, 2015a).

Conclusion

Multiple chronic conditions patients experience poor clinical outcomes. The outcomes are as a result of poor quality of care because the majority of patients with MCC are misunderstood. Understanding and honouring patients with MCC is funded by AHRQ to offer research that can lead to better clinical outcomes and higher quality of care. The program has been given a hefty budget of over a million dollars. The programs strategic plan is to ensure that knowledge gaps in MCC are filled for evidence-based practice. The best way to improve quality of care is to treat the individual chronic conditions during early diagnosis. The high medical expenditures is a problem for patients with MCC. The cost burden can be reduced by examining the interrelatedness of chronic conditions. For instance, diabetes and hypertension are related and therefore treating one disease can help in the treatment of the other.  The program by Group Health organization is valuable and more funds should be allocated for the expanded research. The reason is the high number of patients with MCC that have devastating financial consequences on the health care system in the US.

References

Agency for Healthcare Research and Quality (2015a). Understanding and honoring patients with multiple chronic conditions. Retrieved on 23th December 2017 from https://healthit.ahrq.gov/ahrq-funded-projects/understanding-and-honoring-patients-multiple-chronic-conditions#top

Agency for Healthcare Research and Quality (2015b). Multiple chronic conditions. Retrieved 23th December 2017 from https://www.ahrq.gov/professionals/systems/long-term-care/resources/multichronic/mcc.html

Catherine Y. Lim, Andrew B. L. Berry, Tad Hirsch, Andrea L. Hartzler, Edward H. Wagner, Evette J. Ludman, James D. Ralston.(2017). Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives. J Gen Intern Med, 32(12): 1278–1284

Parekh, A.K., & Goodman, R.A., & The HHS Interagency Workgroup on Multiple Chronic Conditions (2013). The HHS strategic framework on multiple chronic conditions: genesis and focus on research. Journal of Comorbidity, Vol.3,No.2.

Parekh, A. K., Goodman, R. A., Gordon, C., Koh, H. K., & The HHS Interagency Workgroup on Multiple Chronic Conditions. (2011). Managing Multiple Chronic Conditions: A Strategic Framework for Improving Health Outcomes and Quality of Life. Public Health Reports, 126(4), 460–471.

Zulman, D. M., Asch, S. M., Martins, S. B., Kerr, E. A., Hoffman, B. B., & Goldstein, M. K. (2014). Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness. Journal of General Internal Medicine, 29(3), 529–537. http://doi.org/10.1007/s11606-013-2616-9