NEW MODELSOF CARING

W. Daniel Hale, Ph.D.Professor of Psychology, Stetson University

Adjunct Associate Professor of MedicineJohns Hopkins School of Medicine

Special AdvisorOffice of the President

Johns Hopkins Bayview Medical Center(starting June 27, 2011)

The Future of Health Care

Health care challenges that need to be addressed.

Aging society/chronic conditions• Health disparities• Access

Demographic Imperative

United States Population

65 years of age or older

• 1992 12 – 13 %

• 2030 19 – 20 % (projection)

Demographic Imperative

Volusia County

1992 Population – 375,000

65 years of age or older – >20%

Increase In Chronic Conditions

• 87% of 65+ have at least one chronic condition

• 67% of 65+ have two or more chronic conditions

Chronic Conditions: Making the Case for Ongoing CarePartnership for Solutions

Johns Hopkins University and the Robert Wood Johnson Foundation

Chronic Diseases

• More than 133 million Americans live with at least one chronic condition

• Approximately half of these have multiple chronic conditions

• 160 million by 2020• 170 million by 2030

Anderson 2007

People with chronic conditions account for …

• 90 percent of all prescription drugs used• 80 percent of all inpatient hospital stays• 75 percent of all visits to physicians• 85 percent of all health care expenditures

Anderson 2007

• Chronic diseases are the leading cause of mortality, accounting for seven out of every ten deaths.

Partnership to Fight Chronic Disease 2008

Health Care for Chronic Conditions

• Where is most health care provided?

• Who delivers most health care?

• Examples: Glaucoma

Diabetes Mellitus

The data … suggest that care provided in the current acute, episodic model is not cost-effective and often leads to poor outcomes for patients with chronic conditions.

…chronic conditions require continuous care and coordination across health care settings and providers.

Chronic Conditions: Making the Case for Ongoing CarePartnership for Solutions

Johns Hopkins University and the Robert Wood Johnson Foundation

We can find solutions by developing better connections between supportive and clinical care delivery systems.

…we can find solutions by encouraging and supporting patient self-management and family caregiving.

Chronic Conditions: Making the Case for Ongoing CarePartnership for Solutions

Johns Hopkins University and the Robert Wood Johnson Foundation

Partner with religious congregations …

“Faith communities in which people worship together are arguably the single most important repository of social capital in America.”

Bowling Alone: The Collapse and Revival of American Community

Robert Putnam, Ph.D.

Partner with religious congregations …

“In one survey of twenty-two different types of voluntary associations, from hobby groups to professional associations to veterans groups to self-help groups to sports clubs to service clubs, it was membership in religious groups that was most closely associated with other forms of civic involvement, like voting, jury service, community projects, talking with neighbors, and giving to charity.”

Bowling Alone: The Collapse and Revival of American

Community Robert Putnam, Ph.D.

Partner with religious congregations …

“…religiously involved people seem simply to know more people. One intriguing survey…found that religious attendance was the most powerful predictor of the number of one’s daily personal encounters. Regular church attendees reported talking with 40 percent more people in the course of the day.”

Bowling Alone: The Collapse and Revival of American Community

Robert Putnam, Ph.D.

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The Gerontologist, Vol. 37, No. 5 1997

•Hospital and physician leaders supported program.

•Clergy championed congregation-based healtheducation.

•Committed and energetic lay leaders could be identified and trained.

•Self-sustaining programs were established.

The Plan

• Train 12 “Lay Health Educators” (expect attrition, so start with 20 – 25)

• Recruit these volunteers from religious congregations

• Medical professionals would provide instruction and materials

• Lay health educators and medical professionals would conduct programs

1994 - 1995

• Started recruiting – 22 were in our first set of classes

• Classes held at Halifax Medical Center in Daytona Beach

• Ended with 25 (“reverse attrition”)• Two more sets of classes were offered• Total of 59 volunteers trained as lay health

educators

The Gerontologist, Vol. 43, No. 6, 200317

•Showed that a national sample of clergy and laity would be amenable to

partnering.

•Identified areas of most interest:

•Health-related classes•Screenings•Preventive interventions, e.g.,

vaccinations

SURVEY OF LAITY

Sample = 5242/3’s of sample from 5 denominations

– Baptist (19%)– Methodist (17%)– Presbyterian (12%)– Catholic (11%)– Lutheran (10%)

Hale & Bennett, 2003 The Gerontologist

SURVEY OF LAITY

• Would you like to have health programs in your congregation?

Yes = 85%• Are there individuals who would assist?

Yes = 84%• Would you be willing to assist?

Yes = 45%

SURVEY OF LAITY

• Stress management – 56%• Alzheimer’s disease – 53%• Cancer – 51%• Heart disease – 48%• Depression – 48%• CPR – 47%• Advance directives – 45%• Arthritis – 40% • Diabetes – 38%

SURVEY OF LAITY

• Health screenings (e.g., blood pressure)

Yes = 78%• Preventive measures (e.g., flu vaccinations)

Yes = 74%• Exercise programs

Yes = 80%• Support groups

Yes = 82%

“This book literally has the potential to save lives.”

• Book and Media Reviews. JAMA 2009; 302:1911

JHBMC Healthy Community Partnership

• Promotes community health.

• Engages community leaders.

• Addresses health disparity.

• Improves health and lives of our neighbors.

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Dr. Burton was right!