Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

An Overview of Quality Care of People with Complex Health Needs

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

An Overview of Quality Care of People with Complex Health Needs

Article excerpt

In recent years, high percentages of health care expenditures have been associated with a relatively small proportion of the population - people with complex health care needs. Most clients in this high-cost group are those with multiple chronic illness conditions requiring long-term health care services, frequent re-hospitalizations, and limitations on their ability or capability to perform daily functions due to physical, mental and/or psychosocial problems. In the US, health care expenditures for people with multiple chronic conditions are up to 17 times higher than for people with no chronic problems (Anderson, 2007); that is, average per capita spending of US$16,800 (16.9 times) for people with five types of chronic illness conditions versus US$7,381 (seven times) for three types versus US$994 for no chronic illness. In Australia, chronic illnesses accounted for 70% of the total burden of ill health in 2002, as measured by disability-adjusted life-years, and this has been expected to increase to 80% by 2010 (National Health Priority Action Council, 2006). Given the far higher prevalence of complex health needs among this group and the projected growth in the next decades of the aging population, the costs of providing appropriate care for these client populations threatens future viability of health care systems worldwide.

Individuals with complex health needs can be referred to as those with multiple chronic illnesses, in acute, rehabilitative and ambulatory care settings with a particular interest in high risk care transitions (Schoen, Osborn, How, Doty, & Peugh, 2008). No matter how many types of illness that a person may have, each kind of chronic illness itself - such as ischemic heart disease, stroke, colorectal cancer, breast cancer, diabetes mellitus, and mental illness - is one of the top leading causes of ill-health, disability and injury in the US, Australia, Europe, and many other countries (Council of Australian Governments, 2006; O'Grady & Capretta, 2009; United Kingdom Department of Health, 2006).

However, this definition can vary between clients' ages. Children and young people with complex health needs can include those with not only physical diseases but also behavioral difficulties, emotional problems or mental illnesses (McConkey, Barr, & Baxter, 2007). Elderly clients with complex health needs are those with chronic medical problems accompanying issues in an unhealthy aging process. Their needs are generally focused on a better quality of life if they can avoid hospitalization, remain in their homes, and visit their family doctors or community nurses for treatment and care. Although complexity, vulnerability and age may not pre-dispose older people to receive poorer quality of care, some research provides evidence that older clients require timeconsuming processes in health care - such as health assessment and history taking, counseling and medication consultation - and may therefore experience inadequate quality of care (Min et al., 2005). People with noticeable or severe mental health problems are often considered to belong to the client group with complex health needs. This is because they require multi-dimensional and inter-disciplinary approaches of care for their complex conditions, including neurological, emotional, physical, and psychosocial problems and dysfunctions (Chien & Lee, 2011; Chien & Norman, 2009).

As a matter of fact, people with complex health care needs are not a distinct category of patients; they are clients at the far end of a populationwide spectrum ranging from so called 'physically healthy' individuals to people with serious medical and/or psychological problems and high utilization of health care services. The long-term goal of efforts in taking care of these client populations may be to ensure that they can receive appropriate care and management for prevention and treatment of their priority illness conditions. However, new initiatives are required to improve health care safety and efficiency and quality in health care delivery, in which multi-components and multidisciplinary collaborations in care planning and provision are found to be of utmost importance (Grabowski, 2009). …

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