Keywords

collaborative care, disease management, health assessment, patient-centered, quality of care, self-management

Authors

1. Wasson, John H. MD
2. Ahles, Tim PhD
3. Johnson, Debbie BA
4. Kabcenell, Andrea MPH, RN
5. Lewis, Ann MPH
6. Godfrey, Margie M. RN

Abstract

In this article, we use self-reported information from 13,271 older adults and the results from several controlled trials to construct a planned-care management strategy that cuts across diseases and conditions and also addresses health disparities attributed to low socioeconomic status. Three strata result from the interaction of patients' financial status, the presence or absence of bothersome pain and psychosocial problems, and their confidence with self-care. A majority of ambulatory patients generally fall in the first stratum. More resources are required in the 2 remaining strata to attain patient-centered, collaborative care. Because the planned-care management strategy is behaviorally sophisticated, it is likely to be more efficient and effective than strategies based on concepts of disease management that focus on either a single disease or groupings of patients who are "high utilizers" of healthcare. We conclude that modern technologies and related approaches make resource planning for patient-centered, collaborative care feasible and desirable.