Management of acute and chronic illness and disability

Disease Management: A system of coordinated healthcare interventions and communications for populations with chronic conditions in which patient self-care efforts are significant. It supports the physician or practitioner/patient relationship. The disease management plan of care emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies, and evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

Disability: 1) A physical or neurological deviation in an individual makeup. It may refer to a physical, mental or sensory condition. A disability may or may not be a handicap to an individual, depending on one’s adjustment to it. 2) Diminished function, based on the anatomic, physiological or mental impairment that has reduced the individual’s activity or presumed ability to engage in any substantial gainful activity. 3) Inability or limitation in performing tasks, activities, and roles in the manner or within the range considered normal for a person of the same age, gender, culture and education. Can also refer to any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.

Disability Case Management: A process of managing occupational and nonoccupational diseases with the aim of returning the disabled employee to a productive work schedule and employment.

Physical Disability: A bodily defect that interferes with education, development, adjustment or rehabilitation; generally refers to crippling conditions and chronic health problems but usually does not include single sensory handicaps such as blindness or deafness.

Overview for Case Managers

Acute diseases have a rapid onset with a short duration. Appendicitis, flu, pneumonia, acute respiratory distress syndrome and acute renal failure are all examples of acute illness. In contrast chronic diseases are conditions that will require a lifetime of management such as diabetes, lupus, heart failure and chronic renal failure.

Acute diseases may lead to a chronic disease. For example a patient with acute onset of multisystem organ failure may require a ventilator and dialysis. If the patient is unable to wean from the ventilator or if kidney function does not return, the patient would then have a chronic condition.

In managing the patient with acute illness the case manager will assess to ensure the patient will be able to return to their prior living arrangement. They will also assess for any needs the patient may have upon discharge, such as home health or DME. If the patient is not able to return home directly from the hospital they will facilitate transfer to inpatient rehabilitation, a long term acute care hospital or other suitable facility.

A patients with a chronic disease will need to be taught to manage their condition to prevent morbidities and co-morbidities. This includes medication management, lifestyle changes and dietary changes as well as testing and follow up with their healthcare provider. They also need to be educated on the benefits of treatment and the risks of noncompliance. It is important that they understand that chronic diseases will not be cured, but rather managed, so that they will have better quality of life.

Acute illness, chronic illness and disability are all disruptions to the patient and family’s lifestyle. Family members may have to take on additional responsibilities and rely on support systems. The Case Manager can make referrals to support groups or counselors as well as financial resources that may be available. There are also disease based agencies with resources and materials to refer patients and families to.

Also see Chronic Care Model