Combating obesity and other chronic diseases requires more than just clinical interventions, it requires both clinical and community systems to integrate, according to an article published in the September issue of Health Affairs.
Lead author William H. Dietz, MD, PhD, and his co-authors note that several models for care delivery and coordination have been advocated to reduce obesity and improve health outcomes, including the Chronic Care Model, the patient-centered medical home, accountable care organizations and community-centered health homes.
"Each model has its virtues, but none has yet been able to fully deliver the Institute for Healthcare Improvement's triple aim — the simultaneous improvement of patient experience, population health and reduced cost of care," they wrote.
Dr. Dietz and his co-authors propose a new model — an iteration of the CCM —for the prevention and treatment of obesity cost of care in the article.
The model includes:
1. Establishing a system to focus on individual patients and family engagement. According to the authors, models of obesity treatment that have been successful frequently require behavioral changes — including preparing healthy foods and getting more exercise — and families are crucial to these efforts.
2. Reducing the stigma surrounding obesity. An effective model would restructure clinical services by providers to reduce stigmatization of people with obesity. It would also demand physicians and other health professionals to learn behavioral strategies that can motivate patients to change their diet and get started on an exercise routine.
3. Improving integration between clinical and community systems. By collaborating, these systems can help patients lose or maintain their weight. For example, the authors cited partnerships between clinics and the YMCA and other community-based resources that have provided patients with a way of getting regular exercise and nutrition counseling.
Although the challenges for implementing the suggested model are substantial, the authors argue that innovative programs, initiatives and new mechanisms and policies can support the implementation of these approaches. Regardless of the challenges, something needs to change, according to the article.
"It is abundantly clear that the current disease care system provides a poor return on investment and cannot be sustained," concluded the article authors.
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