Training Patients

by JHI Staff on August 6, 2014

For the past century, health care has mostly been about hospital beds and doctors’ offices. This approach made sense, given that the biggest threat to health had been infection, and that medicine knew how to address cancer and heart disease only when cases became advanced enough to require hospitalization.

We’re in the midst of a dramatic change in that model of health care. Infection mortality today is less than a twentieth of what it was. That decline has contributed to much longer average lifespans. That also means that more than two-thirds of people today die of chronic diseases— cancer, heart disease, diabetes and Alzheimer’s.

We’ve made huge strides in our ability to treat these diseases in their advanced or acute stages. The potentially bigger breakthrough is our growing understanding of avoiding these diseases, and of slowing and even reversing their progress and impact when they do take hold. (Alzheimer’s has to a large extent been an exception so far, but advances seem to be on the horizon.)

It is this ability to prevent and manage these diseases as chronic conditions, rather than acute, that most experts believe holds the key to further improvements in lifespan and quality of life. It’s also the best way, experts say, to tame the high costs of health care—in the U.S., three-quarters of the well over $2 trillion dollars a year we spend on health care goes to fighting chronic disease.

Some aspects of chronic disease prevention and management will continue to take place in traditional health care settings. Physical exams in the doctor’s office will be at least as important as ever, as will some types of hospital- or clinic-based screening and diagnostic tools. And those who have non-acute forms of a chronic disease, or who are at high risk of one, may be under closer doctor’s care and on medications, to slow disease progress and avoid the need for acute care.

But when it comes to prevention, and even to management, of these diseases, much will happen outside of conventional health care delivery facilities. For one thing, the biggest component of avoiding or mitigating most chronic disease is getting patients to change their everyday behavior. According to the U.S. Centers for Disease Control’s National Center for Chronic Disease Prevention and Health Promotion, about a third of the U.S. population is obese, a third doesn’t get the recommended minimum amount of daily exercise, a fifth smokes, and a third engages in binge drinking.

All these behaviors are risk factors for chronic disease. The toll they take on our health? According to the World Health Organization, eliminating them would prevent 80 percent or more of all heart disease, stroke, and type 2 diabetes, and more than 40 percent of incidences of cancer. The CDC reports that three-fifths of obese children aged 5–10 years already have one or more risk factors for heart disease, and more than a quarter of them have two or more factors. And the agency estimates the annual medical cost of obesity in the U.S. to be $147 billion, or $1,429 per year higher on average for an obese person than for a person of normal weight.

The U.S. health care system, boosted in large part by the Affordable Care Act, is trying to remake itself around the need to coach people into healthier behavior, and keep a closer eye on those patients at high risk of, or who suffer from, chronic disease. That means going beyond hospitals and physicians’ offices to workplaces, neighborhoods, and even the home. Tactics increasingly include behavioral education and coaching, email and phone outreach, home visits, and electronic remote and self-monitoring. Trust for America’s Health calculates that on average every dollar spent on community-based behavior-change programs returns more than five dollars in health care savings.

After a century and a half of focusing on training clinicians, health care education is now partly shifting its aim to training patients, because many patients can do much more to preserve their own health than physicians or state-of-the-art hospitals can.

We at Johns Hopkins Medicine International have been changing the ways in which we work with our collaborators around the world on large health care system projects. In the past, we mostly thought in terms of building, expanding and improving hospitals, and supporting the wider availability of specialty care, especially in countries that have a shortage of high-quality hospitals. We still largely focus on those efforts, but now we also help our collaborators examine ways to improve population health. Such efforts have for example figured prominently in our collaborations with Trinidad and Tobago, and with the hospitals we have worked with in the UAE.

Every population deserves access to high-quality, safe hospital care, and we’re proud to be working toward that goal. But we’re increasingly aware that these efforts are just one component of health. We’re working hard to address the others, and hopefully more of the population will join the effort to keep people from getting seriously ill enough to really need to go to a hospital.

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Basem Hammami August 12, 2014 at 10:44 am

Dear Dr. Thompson.
I have been enjoying reading your blog. I am a healthcare Architect who worked on many projects in the Middle East and have been following what US healthcare systems are introducing to that region of the World. I wanted to thank you for all the efforts you are doing and wanted to let you know how much I appreciate the concept of “training Patients” and improving wellness and not just providing a standard healthcare service for fee.
As a designer, I truly believe in the Power of the healthcare facilities and its role in the community in extending wellness programs and being a destination for community social events, health/Wellness education and Patient Training.
My last project in Dubai was the University Teaching Hospital in affiliation with Harvard Medical International. I tried to convince the hospital Owner “The Government of Dubai” to provide adequate spaces for the community in the form of multi-purpose rooms where the Public would be invited to learn about Integrative Medicine, healthy cooking, weight management and other great wellness concepts I would apply to my projects in the US. Unfortunately, all these ideas were put aside because of the return on investment would not translate into $$$.
I am hoping that one day, I will get an opportunity to work on a project overseas where these concepts are appreciated.
Again, thank you and Johns Hopkins for all the work
Basem Hammami

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