Quality Metrics for Chronic Disease Management

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Chronic diseases, by their nature, are different and are treated differently from accidents, injuries, and ordinary diseases that require treatment in a hospital facility, but then after treatment are no longer of concern. And though chronic diseases are generally more serious than these other kinds of events that can occur to a person, they do not require a typically urgent response such as an accident or injury would require. Boville, Saran, Salem, Clough, and Jones (2007) write concerning diabetes patients and the use of a Collaborative Intensification Model designed to improve clinical outcomes for those patients.

Such a model, which is also effective with other chronic diseases, also responds very well to an economic outcome, resulting in the curtailing of increasing costs for long-term care that a chronic disease demands. The Medical Advisory Secretariat (2009) in Toronto, Canada, suggest that diabetes management may best be addressed by a multidisciplinary approach, including a family physician, diabetes specialists, and diabetes educators that would be culled from the ranks of registered nurses and/or registered dietitians. Allied healthcare professionals and those in community health may also be a part of whatever treatment is appropriate for type II diabetics.

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A typical control plan template, as outlined by the Medical Advisory Secretariat (2009), may include such metrics as door to radiology time, with the benchmark (Ettorchi-Tardy, Levif, and Michel, 2012) being less than five minutes, registration time less than two minutes, registration wait time less than one minute, registration patient satisfaction score 85% satisfactory or greater, and employee satisfaction score 85% or greater. The same metrics, however, might not apply in other settings. In the case of a diabetic who is homebound, such metrics make no sense in his or her environment. Likewise, a diabetic who is in skilled nursing care or in long-term nursing care would not receive the same benchmark urgency as he or she would receive in the hospital setting. The management of chronic disease conditions is primarily the patient’s responsibility, anyway, since there is not typically the urgency with these conditions as there are with more serious (temporarily) issues as injury or accident. Of course, it is everyone’s desire that these chronic diseases be ameliorated as much is possible, and having appropriate metrics for such is a necessary component of any treatment, as much as pharmaceutical interventions would be. But having benchmarks and quality metrics certainly gives the patient something to understand his or her condition by, and gives a target to medical professionals both in giving the patient treatment advice, and in navigating their own systems of treatment.

Current automated trigger systems in most treatment models are as up-to-date as they can be given the current knowledge of chronic diseases that we have. Certainly some of these automated trigger systems are reactive, especially in a hospital setting, when a patient is admitted with a situation that is beyond his or her control at the moment. But for daily care with chronic diseases, automated trigger systems and treatment protocols are certainly proactive in that they allow the patient to treat his or her own illness in his or her own environment.

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