Continuum of Care: Why rural health care may benefit the most from a new model
Kati Eggen, BSN, RN
Recently when I was going through my Facebook feed, I came across an article written by an ED physician that perfectly explained what drove me out of critical care medicine. This article, which was written by Dr. Louis Profeta, MD, compared how elderly patients spend their last days of life today versus 50 years ago. He noted the differences and how today we focus on extending lives, regardless of the quality of that life, and how in years past, the focus was on making them comfortable. He used eloquent prose to ask the question, when is enough, enough? When did we lose the distinction between prolonging quality of life and simply prolonging life?
After reading this article, I was compelled to share it on my timeline. I was surprised by the responses I received. Nearly all of my health care friends felt the way I did. That we were focusing too much on extending life instead of ensuring quality of life.
When I left my position as an ICU nurse after five short years, a position I had worked hard to obtain, it was difficult for me to explain to my friends and family that were not in the medical field why I made my decision. The truth was that in the majority of cases I was not saving lives, I was merely helping to prolong life. Many times the invasive, painful procedures bought my patients mere days at the cost of being surrounded by their loved ones. Instead, they were being swarmed by strangers who would poke and prod them, trying to find the “best” way to extend their lives, with tubes snaking in and out of their bodies. In his article, Profeta says, “(Ours is a) system that now herds these families down dead-end roads and prods them into believing that this is the new norm and that somehow the old ways were the wrong ways and this is how we show our love.”
Figuring how to reverse this trend of blindly leading patients from one invasive medical procedure to another, instead of discussing their entire treatment strategy early in the disease process is an important step in finding the correct treatment path. Ensuring that this plan works well with the beliefs, lifestyle and goals of the patient and their families is even more important to reaching the long term goal of better care.
One potential answer to meeting this goal can be found in the care delivery systems that concentrate on the Care Continuum model, one that functions as a bridge between advances in medicine and common medical and nursing sense. According to the Health Information and Management Systems Society (HIMSS), the Continuum of Care is a concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care.
The Continuum of Care covers the delivery of health care over a period of time, and may refer to care provided from birth to end of life. Health care services are provided for all levels and stages of care. This method helps to increase patient quality of life and caregiver job satisfaction while decreasing the cost of care. The Care Continuum is an answer to the over-use of advanced medical technology, ensuring it is used only when appropriate, helping patients and their family members gain control over their medical journey towards the path they are most comfortable with.
Changes like this do not happen overnight, so the question is: Where is the biggest opportunity to positively impact patient care and care giver satisfaction? Statistics from the Census Bureau show that the largest percentages of elderly patients reside in less populous states. Additionally, over half (57%) of individuals 84 years and older live alone. Logic and statistics tell us that as a person ages, the need for health care increases, so these areas with higher percentages of aged populations would have the greatest need for health care.
The 2010 National Hospital Discharge Survey backed this up, showing that a higher percentage of inpatients in rural hospitals were 65 and over (51%) compared to their urban counterparts (37%). This survey also noted that the average number of diagnosis and length of stay was similar between the rural and urban hospitals, but the difference came in the types of treatments rendered. In the rural hospitals, 64% of inpatients had no procedures performed, compared to 38% of urban hospital inpatients.
Taken as a stand-alone statistic, one could incorrectly surmise that the care in the rural hospitals was not at the same quality level as their urban counterparts, but according to the Archives of Internal Medicine, studies have found that the less money spent in the final stages of life, the better the death experience was for the patient. When you combine this information with what can be gleaned from the Forbes article, “Why 5% of Patients Create 50% of Health Care Costs” it is easy to see that a well-thought-out care plan can prevent unnecessary, costly procedures that can interfere with a patient’s personal goals and quality of life.
Rural health care facilities are uniquely suited to successfully embrace the Care Continuum model as they are caring for the highest percentage of elderly and chronically ill patients who benefit the most from this care plan.
This ever-evolving topic will be covered by Ruth Ann Perr, Physician Specialist with CPSI, who will be hosting a session at NRHA’s Critical Access Hospital Conference titled “The Change from Bedside Care to Care Cycle.” She will discuss the changes towards the Care Continuum model and how it impacts rural health care providers and what you can do to make a positive impact on your patients.
NRHA commissioned the above piece from CPSI/Evident, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.