Week 10: Chronic Disease Management: Mortality and Morbidity
The management of chronic disease poses a significant health care challenge in the United States and elsewhere. By the year 2030, chronic disease will cost the world over 47 trillion dollars annually (Bloom, et al, 2011; Jaslow, 2011). As noted in Week 6, many of the factors that contribute to chronic illness—such as poor diet, lack of activity, drug and alcohol use, and smoking—are lifestyle choices. Consider, for instance, diabetes: the significant increase in prevalence from 1980 to 2007 is explainable almost entirely by lifestyle choices. Most adults report having the condition long term, and the direct and indirect costs associated with it are substantial (Nash, Reifsnyder, Fabius, and Pracilio, 2011).
As a nurse leader, what opportunities do you see for reducing morbidity and mortality—and, ultimately, for diminishing the tremendous personal and societal costs—related to chronic disease?
You have explored many of the facets of epidemiology throughout this course; this week, you will examine the study of chronic disease. You will investigate models and frameworks for managing chronic disease, as well as how the challenges of managing chronic disease inhibit the delivery of quality health care.
Learning Objectives
Students will:
· Analyze a chronic disease model and its relationship to a chronic disease
· Evaluate current challenges in delivering effective quality health care as it relates to chronic disease management
  
Learning Resources
Required Readings
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Structure, systems, and stakeholders. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
In Chapter 4 the current structure of the United States health system and the influence on population health is discussed. Stakeholders are identified, and the relationships between the structure, system and stakeholders is  explored.
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Coordinated care delivery models. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
Chapter 12 examines the influence of accountable care organizations and ambulatory care organizations on the current health care delivery system. Examples of successful organizations are explored.
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Developing the workforce to enhance population health. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
In Chapter 7 the authors address the social determinants driving population health. The strategies needed to develop a workforce that will be able to support current population health strategies is discussed. 
Dossey, B. M., Rosa, W. E., & Beck, D.-M. (2019). Nursing and the sustainable development goals: From Nightingale to now. AJN American Journal of Nursing, 119(5), 44–49. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NAJ.0000557912.35398.8f
Easley, C., Petersen, R., & Holmes, M. (2010). The health and economic burden of chronic diseases in North Carolina. North Carolina Medical Journal, 71(1), 92-95.
This short reading presents an analysis of the economic effects of selected chronic diseases resulting in increased hospitalization, with a focus on behaviors that may be changed to prevent these diseases.
Kim, T. W., Saitz, R., Cheng, D. M., Winter, M. R., Witas, J., & Samet, J. H. (2011). Initiation and engagement in chronic disease management care for substance dependence. Drug & Alcohol Dependence, 115(1-2), 80-86.
This article presents a study on treating substance abuse as a chronic disease. The authors discuss challenges to treatment options and propose methods for more appropriately managing treatment for substance dependence as a chronic illness.
Tenforde, M., Jain, A., & Hickner, J. (2011). The value of personal health records for chronic disease management: What do we know? Family Medicine, 43(5), 351–354.
This reading examines evidence related to the value of electronic personal health records (PHRs), noting that additional research is needed to evaluate this for chronic disease management.
United Nations. (2011, September 19). Non-communicable diseases deemed development challenge of ‘epidemic proportions’ in political declaration adopted during landmark general assembly summit. Retrieved from http://www.un.org/News/Press/docs/2011/ga11138.doc.htm
 
The United Nations met in September 2011 to collaborate on global plans to address the control and prevention of chronic diseases. This report from the general assembly notes the high cost of not managing chronic disease worldwide.
 
Yale School of Public Health. (2012). Chronic disease epidemiology. Retrieved from http://publichealth.yale.edu/cde/index.aspx
 
Yale School of Public Health sponsors this site. Explore the information presented on addressing chronic disease through epidemiology.
 
Florida Department of Health. (n.d.). Bureause of epidemiology: Surveillance and investigation guidance. Retrieved March 5, 2012, from http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/surveillance-and-investigation-guidance/index.html
 
This Florida-based agency monitors chronic disease conditions in Florida’s population using a variety of population-based surveillance systems.
 
World Health Organization. (2012). Chronic diseases and health promotion: Integrated chronic disease prevention and control. Retrieved from http://www.who.int/chp/about/integrated_cd/en/
The World Health Organization monitors chronic diseases worldwide. This website provides an overview of their programs, monitoring efforts, and activities they engage in to reduce the incidence of chronic disease globally.
 
  
Discussion: Addressing Chronic Disease
According to the Population Health course text, “Roughly 40 million Americans are still uninsured and 112 million Americans (almost half of the U.S. population, 45%) suffer from at least one chronic condition in the United States, an estimated 125 million persons have at least one chronic condition, and half of these persons have multiple chronic conditions” (Nash, Skoufalos, Fabius, and Oglesby,  2021, p. 5 ).
This week’s Learning Resources examine numerous health problems that result in a need for ongoing care. As you have explored this week, many costs are associated with chronic disease—both in terms of lives lost and socioeconomic burden. What can be done to help reduce chronic disease at the population level?
For this Discussion, you will take an in-depth look at chronic disease, and you will evaluate ways to address this issue through the application of chronic disease models and frameworks. In addition, you will consider the impact of the challenges of managing chronic disease on quality of care delivery.
To prepare:
· Review the application of chronic disease models as a method for managing chronic diseases at the population level.
· Consider characteristics of chronic disease models and how to apply them as presented in the Learning Resources.
· Consult The Chronic Care Model (Figure 1–1 (p. 9) in Population Health: Creating a Culture of Wellness, and consider examples of determinants and outcomes of population health with chronic diseases in a specific subpopulation. Then, select one chronic disease on which to focus for this Discussion.
· Ask yourself, “What are the challenges of managing this chronic disease? How do these challenges limit the ability to deliver effective quality care?” Conduct additional research using the Walden Library and credible websites as necessary.
By Day 3
Post a cohesive scholarly response that addresses the following:
· Identify your selected chronic disease.
· Describe the application of a chronic disease model to address this disease at the population level. Include your rationale for selecting this particular model.
· Discuss one or more current challenges related to the management of the chronic disease, and explain how these challenges limit the ability to deliver effective quality care.
1.5 pages in APA and cite at least 3 sources
  
Assignment: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem
Continue improving upon your paper, paying careful consideration to the feedback you have received on the publishs you have submitted in previous weeks. Your Final Paper will be due by Day 3 of next week.
  
Week in Review
This week, you analyzed a chronic disease model and its relationship to a chronic disease and evaluated current challenges in delivering effective quality health care related to chronic disease management.
In the final week, you will consider emergency preparedness and disaster management strategies and how these strategies are used to cope with disasters.
To go to the next week:
Week 11
More sources
https://www.who.int/home/cms-decommissioning
https://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/index.html
https://journals.lww.com/ajnonline/Fulltext/2019/05000/Nursing_and_the_Sustainable_Development_Goals_.27.aspx