Chronic Disease. Gerard Anderson Professor Johns Hopkins University
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1 Chronic Disease Gerard Anderson Professor Johns Hopkins University
2 The lives of far too many people in the world are being blighted and cut short by noncommunicable chronic diseases such as heart disease, stroke, cancer, chronic respiratory disease and diabetes. This is no longer only happening in high income countries... Globally, of the 58 million deaths in 2005, approximately 35 million will be as a result of non-communicable chronic diseases. They are currently the major cause of death among adults in almost all countries. -Former Director General of WHO, Lee Jong-wook
3 The Number Of People In US With Chronic Conditions Is Increasing Rapidly In 2000, 125 million Americans had one or more chronic conditions. Between 2000 and 2030, the number of Americans with chronic conditions will increase by 46 million people. Number of People With Chronic Conditions (millions) Year Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.
4 One In Four Americans Has Multiple Chronic Conditions 30% 25% 23% Percent of All Americans 20% 15% 10% 12% 6% 5% 4% 4% 0% Number of Chronic Conditions
5 Children with Chronic Conditions Generally Have a Single Condition Children with Upper Respiratory Disease 67% 25% 8% Children with Asthma 64% 27% 9% Children with Eye Disorders 65% 26% 9% Children with Disorders of Teeth and Jaw 75% 17% 7% Children with Lower Respiratory Disease 69% 17% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Condition Alone Condition+1 Condition+2 Source: Medical Expenditure Panel Survey, 2004.
6 Most Adults With A Chronic Condition Have More Than One Condition Adults with Hypertension 23% 28% 21% 14% 15% Adults with Upper Respiratory Disease 33% 28% 16% 10% 13% Adults with Disorders of lipid metabolism 15% 26% 24% 15% 20% Adults with Chronic Respiratory Infection 37% 29% 14% 10% 11% Adults with Arthritis 17% 25% 18% 15% 25% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+ Source: Medical Expenditure Panel Survey, 2004.
7 Seniors With A Chronic Condition Rarely Have A Single Condition Seniors with Hypertension 11% 21% 21% 21% 26% Seniors with Arthritis 7% 17% 21% 21% 35% Seniors with Heart Disease 6% 13% 20% 22% 38% Seniors with Eye Disorders 9% 16% 21% 19% 36% Seniors with Diabetes Mellitus 4% 12% 20% 25% 38% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+ Source: Medical Expenditure Panel Survey, 2004.
8 People With Chronic Conditions Accounted For 85 Percent Of All Health Care Spending In % Health Care Spending for People without Chronic Conditions 85% Health Care Spending for People with Chronic Conditions Source: Medical Expenditure Panel Survey, 2004.
9 Sixty-Five Percent Of Health Care Spending Is On People With Multiple Chronic Conditions Percent of Health Care Total Spending by Number of Chronic Conditions 5+ Chronic Conditions 21% 0 Chronic Conditions 15% 4 Chronic Conditions 12% 1 Chronic Condition 20% 3 Chronic Conditions 14% 2 Chronic Conditions 18% Source: Medical Expenditure Panel Survey, 2004.
10 Two-Thirds Of Medicare Spending Is For Beneficiaries With Five Or More Chronic Conditions 1 Chronic Condition 3% 0 Chronic Conditions 1% 2 Chronic Conditions 6% Percent of Medicare Expenditures 3 Chronic Conditions 10% 4 Chronic Conditions 12% 5+ Chronic Conditions 68% Source: Medicare Standard Analytic File, 2004.
11 Health Care Spending Increases With The Number Of Chronic Conditions Average Per Capita Health Care Spending $18,000 $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $16,819 $10,091 $7,381 $5,062 $2,753 $ Number of Chronic Conditions Source: Medical Expenditure Panel Survey, 2004.
12 Poor Care Coordination Leads To Unnecessary Hospitalizations Ambulatory care sensitive conditions (ACSCs) are conditions for which timely and effective outpatient primary care may help to reduce the risk of hospitalization. Hospitalizaitons for Ambulatory Care Sensitive Conditions Per 1000 Medicare Beneficiaries Ages Number of Chronic Conditions Source: Medicare Standard Analytic File, 2001.
13 Physicians Believe That Poor Care Coordination Produces Bad Outcomes Receipt of contradictory information 54% Emotional problems unattended 49% Adverse Outcomes Adverse Drug Interactions Unnecessary hospitalization Patients not functioning to potential Experience of unnecessary pain 36% 34% 34% 44% Unnecessary nursing home placement 24% 0% 10% 20% 30% 40% 50% 60% Percent of Physicians Who Believe that Adverse Outcomes Result from Poor Care Coordination
14 People With Serious Chronic Conditions Believe They Do Not Receive Needed Treatment 80% Percent of People with Serious Chronic Conditions Reporting That They Did Not Receive Needed Care 70% 60% 50% 40% 30% 20% 10% 46% 43% 59% 71% 57% 46% 0% Total White Non-White Hispanic Uninsured Insured Source: Serious Chronic Illness Survey, conducted by the Gallup Organization, 2002.
15 Problems To Overcome Clinical research complicated patients excluded form clinical trials Medical education specialty not coordinated care is focus of medical school curriculum Payment and delivery systems- acute not chronic care orientation Quality measurement- care coordination and multiple chronic problems
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