Leadership in

Managing Chronic Illness

Sharon A. Denham, PhD, RN, CNE

Professor Emeritus, Ohio University School of Nursing
Professor, Texas Womans University< College of Nursing
Houston J. & Florence A. Doswell Endowed Chair in Nursing for
Teaching Excellence
Objectives

Differentiate among the things that influence management of chronic

illness.

Identify ways coordinated care can address prevention, wellness, and

management of chronic disease self-management.

Identify ways nurse leadership can aid chronic care management.

 Health & Illness
Define illness

Define health

Define wellness

Identify two traits of chronic illness

 Chronic Illness
Who are the true care managers?

Nurses need to be effective guides, coaches, & promote

independence

Communities need to support those managing chronic

illness

Solutions that are high touch and high tech

Chronic Illness
Symptoms fluctuate over time
As symptoms change, challenges & needs change
Individual & family face adaptive changes over time
Care is co-produced within the family household
Family collaborative work
https://www.youtube.com/watch?v=XIG1ZQFxTvs
 Complexity of
Chronic Disease Management
Household Niche
$$$
Motivation
Resources
Routines

Interactions

Personal Traits
Community
Societal Circumstances

Values
Social Networks
Living in Rural
Places
 Living in Rural Places
Lower family income

Transportation challenges

Limited healthcare access

Lower life expectancy

More people with

disabilities

Education & social

resources

Long memories
 Rural Concerns
Foreign clinicians - Language
barriers

Physician turnover

Paying for medical care

Distance and costs to see

specialists

Medication
Families
Living with Chronic Illness
Living with Chronic Illness
Chronic Illness
 Medical Care: At What Cost????
The surgery was a success, the bills afterward were a shock. The total bill
was $28,000, the insurance paid about $5,000.

$9,000 for the CT scan, & with your

COST DISPARITIES insurance you still owe $6,500
Colonoscopy costs = $840 at freestanding office run by a gastroenterology group
BUT $4,481 = Academic Medical Center

$31,700 for surgery of a brain hemorrhage

The insurer said Usual, customary & reasonable price = $111,875

Surgeon charged = $591,875
Patients bill = $480,000
Insurance companies pay for tests for certain conditions,
.or so many times a year - without knowing details, dont know
what must be paid out of pocket.

Reattaching a finger severed in a table-saw accident = $83,000

U.S.totalhealthcarespending=$4.8trillion(2021)
$2.6trillionin2010
$75billionin1970
Healthcarespendingwillaccountfornearly20%ofgross
domesticproduct(GDP)or1/5oftheU.S.economy.
CentersforMedicareandMedicaidServices,NationalHealthExpendituresProjections(20112021)

49millionAmericanslackedhealthinsurancein2011
U.S.CensusBureau,Income,PovertyandHealthInsurance

CoverageintheUnitedStates:2011.September2012

6.8% overall increase in health care costs (2015)

PricewaterhouseCoopers Health Research Institute Report
 What is Health Care?
Prevention, treatment, management of illness and disease.
Preservation & management of mental and physical health and well-being.
Services offered by the medical and allied health professions.

Ultimate goal of primary health care is better health for all (WHO):

1. Reduce exclusion and social disparities in health;

2. Organize health services around people's needs and expectations;

3. Integrate health into all sectors (public policy reforms);

4. Pursue collaborative models of policy dialogue (leadership reforms);

5. Increase stakeholder participation.

Medical Model
Ecological Model
(Bronfenbrenner, 1976)
www.diabetesfamily.net/family/family-health-model/
Meet Individual -
Think Family Household
Family Context
Family Function
Family Health Routines
(Structure)
Chronic Illness & Self-Management

Secret of Success is about Daily Routines

Individual Disease - Family Choices
Chronic Disease
Self-Management

Social determinants of health

Excellent communication skills - Hear patient stories
Interdisciplinary collaboration
Care coordination
Involve family and friends
Rethink educational needs
Create meaningful measurable action plans
Identify needed resources
Nurses Roles
Communication skills
Assessment (context, function, routines)
Respect individual & family values
Address complications & prevention
Involve other team members
Identify desired care outcomes (give rationale)
Leader in practice: Advocacy (what does it look
like?)